The Patient Care Coordinator is responsible for utilization review, discharge planning & transitions in care, in collaboration w/ MAPMG rounder in acute or alternative settings of care.
Essential Functions:
- Utilization Review. According to department policy, procedure & protocols, consistently apply & verbally communicate approved utilization review criteria & guidelines for services delivered in acute or alternative care settings.
- Eligibility & Benefit Verification. Confirm eligibility status & ensure the appropriate administration of benefits in accordance w/ department policies & procedures.
- Assessing Right Venue of Care w/ Hospitalist. Collaboration w/ Hospitalist to assess the appropriate level of care for patients (i.e., Medical Unit, Surgical Unit, Tele Unit, TCU, ICU) & post- (Home, Continuum or Community-based Services) hospitalization.
- Coordination of Care. Driving patient care plan through assuring daily plan is executed, & management of transitions & post-hospital care.
- Effective Discharge Planning. Prompt, clinically appropriate discharge planning beginning at time of admission.
- Variance Management. Timely steps in identification of delays in throughput, escalation to correct delays, & recording delays to identify patterns & trends that will require corrective actions.
- Quality Screening. Demonstrate competency to assess all aspects of care across the continuum for variations from quality & utilization standards.
- Performs other related duties as directed.
Qualifications:
Schedule Details:
- This position has a rotating schedule to include weekends and holidays.
Basic Qualifications:
- 2 years of experience in acute hospital utilization review or equivalent required.
- RN License in jurisdiction where assigned required.
- CPR certification required.
- New Hire:
o Successful completion of PCC Orientation & Assessment of Critical Skills.
o Passing score on inter-rater reliability.
- Annually:
o Successful completion of PCC Assessment of Critical Skills.
o Passing score on inter-rater reliability.
- Ability to effectively communicate.
- Ability to conform to established policies & procedures.
- Ability to analytically problem solve & make decisions.
- Ability to tolerate & cope w/ ambiguity.
- Ability to work as a team member.
- Proficiency in the use of applicable computer software.
- Demonstrated ability to effectively & clearly present information through the written word, to influence or persuade others through oral presentation in positive or negative circumstances, & to listen well.
- Demonstrated ability to write clearly, legibly, & effectively, to present ideas & document activities, to read & interpret written information.
Preferred Qualifications:
- Recent acute care, case management, or home health experience preferred.
- B.S.N. preferred.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.