Instructions:

Please rate your experience / frequency (within the last year) using the following scale (check the appropriate boxes below):

  • 0 = No Experience / Observed Only
  • 1 = Limited Experience / Rarely Done (<6 times/year)
  • 2 = May Need Some Review / Occasionally Done (1 - 2 times/month)
  • 3 = Experienced / Frequently Done (daily or weekly)
    		•
    AGE OF PATIENTS CARED FOR
    Newborn/Neonate (birth to 30 days)
    Infant (1 month to 1 year)
    Toddler (1 year to 3 years)
    Preschooler (3 years to 5 years)
    School Age Child (5 years to 12 years)
    Adolescents (12 years to 18 years)
    Young Adults (18 years to 39 years)
    Middle Adults (39 years to 64 years)
    Older Adults (64 years to 79 years)
    Elderly Adults (over 79+ years)
    SKILLED ENVIRONMENTS
    Acute Care/ Hospital
    Managed Care
    SNF/ Long Term Care
    Home Health
    Outpatient
    GENERAL SKILLS
    Written Communication Skills
    Verbal Communication Skills
    Basic Negotiation Skills
    Job Related Computer Skills
    Ability to Prioritize
    Knowledge of Community Health Care and Vocational Services
    Ability to Properly Maintain Records
    Knowledge of Medical Billing Procedures
    Ability to Work Effectively in All Situations
    Ability to Assess, Plan, Implement and Evaluate Individual Patient Care Programs and Treatment Plans
    Ability to Gather Data, Compile Information and Prepare Reports
    Ensure Outcomes are Met within an Appropriate Length of Stay
    Coordinate and Monitor Services, Including Comprehensive Tracking of Client Activities in Relation to Care Plan
    Conduct Medication and Mental Status Assessment and Determine Required Level and Frequency of Service
    Document According to POC
    Complete and Submit Billing Documentation as Appropriate
    Identify and Provide Emergency Crisis Services as Necessary
    Make Immediate Clinical Assessments and Respond According to Accepted Crisis Intervention Methods and Techniques; Coordinate Other Services as Appropriate
    Ability to Develop and Implement Action Plans for Health Centers to Improve Performance
    Establish Goals
    Knowledge of Obtaining Available Community Resources
    Knowledge of Medical/State Regulations
    Ability to maintain professional boundaries of a professional or ethical nature
    Self-awarness of how actions, perceptions and potential biases may affact client outcomes
    Ability to advocate for social justice and empower clients and communities
    Ability to Deliver Services That Meet Cultural and Linguistic Needs of Patients
    EXPERIENCE
    Develop and Review Care Plan to Meet Patient Needs
    Establish and Revise Goals
    Infection Control- Handwashing, PPE, Exposures
    Disability Review
    Pre Certification/ Pre-Admission Certification
    Catastrophic Case Management
    Continued Stay Review
    Effective Case Coordination
    Discharge Planning
    Criteria for Hospital Admissions
    Intensity of Service - Diagnosis & Therapeutic Services
    Discharge Screens - Specific Indicators of Patients Ability
    Appropriateness of Care - Special Diagnosis and Therapeutic Procedures
    Prior Authorization
    Electronic Documentation