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Patient Care Coordinator
2 months ago
SUMMARY: The role involves overseeing, negotiating, and arranging services while securing prior authorizations. The Case Manager will perform discharge planning assessments and manage the care of intricate patients to ensure optimal quality and cost-effective outcomes. This position requires collaboration with the interdisciplinary team, both within and outside the organization, and participation in quality improvement initiatives related to patient care management, including handling appeals and denials.
KEY RESPONSIBILITIES:
1. Conducts admission and ongoing utilization review processes in accordance with established criteria and guidelines.
2. Evaluates the various dimensions of patient functioning, including physical, psychological, social support systems, and financial resources.
3. Identifies the necessity for case management services at various stages within the healthcare continuum.
4. Collaborates with all healthcare team members, including patients and their decision-makers, to devise a high-quality, realistic, and resource-efficient care plan for identified patients.
5. Makes suitable referrals utilizing available community and regional resources.
6. Develops a comprehensive network of essential services and disciplines required by patients.
7. Maintains a thorough understanding of payer requirements frequently encountered within the patient population.
8. Adheres to all payer contracts and programs, including procedures for denials and appeals.
9. Ensures direct communication with facility representatives during referrals to the next level of care.
10. Facilitates the transfer of necessary documentation and data with the patient to the subsequent level of care.
11. Analyzes variances from expected outcomes concurrently to determine the need for intervention.
12. Works collaboratively with the healthcare team to document patient status and variances, striving for the achievement of patient goals and optimal quality and cost outcomes.
13. Maintains comprehensive and accurate documentation of all Case Management activities.
14. Provides leadership by enhancing the understanding of the integrated Case Management Process among all healthcare team members.
ADDITIONAL RESPONSIBILITIES:
1. Participates in emergency, fire, and disaster drills.
2. Demonstrates the ability to care for and maintain equipment appropriately.
3. Attends mandatory training sessions as required.
4. Participates in required staff meetings.
5. Adheres to punctuality and attendance policies.
6. Follows policies and procedures regarding sick leave and unscheduled absences.
7. Complies with dress and grooming standards.
8. Completes in-services and health examinations as mandated by regulatory agencies.
9. Exhibits courtesy and congeniality in all interactions.
10. Ensures confidentiality and compliance with privacy regulations.
11. Accepts additional responsibilities as assigned.
12. Weekend shifts may be assigned on a rotating basis.
SUPERVISORY ROLE: None
EDUCATION AND EXPERIENCE:
1. Minimum of two years of clinical experience in a hospital setting (e.g., Med Surge, ICU, ED).
2. Preferred experience in utilization review and discharge planning within an acute hospital environment.
3. Bilingual proficiency in English and Spanish is preferred.
CERTIFICATIONS:
1. Associate Degree in Nursing is required; Bachelor's Degree in Nursing is preferred.
2. Certification in Case Management (CCM) or a comparable certification is preferred.
3. Current AHA Basic Life Support certification is required.
4. Active, current, and unencumbered Registered Nurse (RN) License in the State of California is required.
