Healthcare Coordinator

1 month ago


Oakland, California, United States Alameda Health System Full time

At Alameda Health System, we are seeking a skilled Nurse, Care Management to join our team. This is a rewarding opportunity for a dedicated professional who wants to make a difference in the lives of patients and their families.

About the Role

The Care Management Specialist will play a vital role in coordinating continuum of care and discharge planning activities for assigned patients. As a key member of the healthcare team, you will develop plans of care and discharge plans, monitor all clinical activities, make recommendations for alternative levels of care, and identify cost-effective protocols.

Responsibilities
  1. You will coordinate all utilization review functions, including response to payor requests for concurrent and retrospective review information, applying medical necessity criteria to determine level of care.
  2. Assure clinical interventions are appropriate for admitting diagnosis and Level of Care, identifying inappropriate admit status based on identified criteria, and ensure patient registration at the appropriate level of care.
  3. Takes action when cases do not meet criteria, escalating to attending physician and Care Management physician advisor for determination, prepares case reports, documents treatment plan, progress notes, and discharge summary related information as required by Medicare, MediCal, Title 22, and other mandated regulations.
  4. Develops, evaluates, and coordinates comprehensive discharge plans in conjunction with patients/family, physician, nursing, social work, and other healthcare providers and agencies, completing initial assessments within 24 hours of admission and documenting findings in electronic health records.
  5. Identifies potential problems, prevents, and resolves barriers to discharge plans, mobilizing resources to effect rapid and timely movement of patients through the system to achieve targeted discharge times established by AHS.
  6. Mobilizes patients and family strengths to optimize use of healthcare and community resources, guiding/assisting in securing needed post-discharge services.
  7. Collaborates with Care Management teams for high-risk patients for timely follow-up appointments, confirming prior to discharge that complex patients are appropriately linked to community services.
  8. Provides community resource education and coaching, focusing on individual patient self-management principles, ensuring continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning, and obtaining authorizations/approvals as needed for outside services for the patient.
  9. Communicates with physicians and multidisciplinary health team members to provide continuity of care, supporting and maintaining the multidisciplinary team approach to ensure effective resource utilization and appropriate level of care.
  10. Makes independent assessments and recommendations regarding course of action in complex situations.
Qualifications
  • Active licensure as a Registered Nurse in the State of California
  • Active BLS - Basic Life Support Certification issued by the American Heart Association
  • Other advanced life support certifications may be required per unit/department specialty according to patient care policies
  • CPI - Crisis Prevention Intervention Training (required for all positions at John George Psychiatric Pavilion; and certain positions in the Emergency Department)
  • Certification in Case Management, CCMC or ACM preferred
  • Bilingual preferred
Compensation and Benefits

We offer a competitive salary range of $120,000 - $150,000 annually, depending on experience, plus benefits including health, dental, and vision insurance, retirement savings plan, paid time off, and opportunities for career growth and development.



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