Senior Clinical Care Coordinator
4 weeks ago
At MedPOINT Management, we are seeking a highly skilled and experienced Inpatient Senior Nurse Case Manager to join our team. This role is responsible for providing overall coordination in the delivery of medical services and discharge planning for a specified patient population.
Key Responsibilities:
- Conduct concurrent review of patient medical records for purposes of utilization review, compliance with requirements of external review agencies, and quality assurance.
- Promote a cooperative and supportive relationship as liaison with patient, family, facility staff, physicians, funding representatives, and community agencies.
- Ensure continuity in the handoff of patient clinical information from the hospital to other involved healthcare entities.
- Provide coverage as needed and follow concurrent policies, procedures, and workflow.
- Attend daily inpatient meetings to review bed day reports with Medical Directors and assist Lead/Supervisor as needed.
- Review and maintain bed day logs weekly and monthly to ensure timely closure of Status "I" or pending/open cases.
- Notify Lead/Supervisor of the number of open cases daily.
- Refer potential quality of care issues to the QI Department for review.
- Assist Lead/Supervisor on Health Plan requests, DMHC requests, and Grievances.
- Assist Lead/Supervisor on reporting as needed, including scrubbing, health plan ad hoc reports, and client ad hoc reports.
- Assist Lead/Supervisor in tracking hospital cap opportunities and escalate timely.
- Assist Lead/Supervisor in tracking and reporting High Acuity cases.
Requirements:
- Current RN or LVN licensure; Preferred: BSN level of education.
- Registered Nurse or Licensed Vocational Nurse with clinically focused work history.
- Prefer three-five years clinical experience within an acute healthcare setting with recent work history in acute care case management or related healthcare experience.
- Working knowledge of case management philosophy, process, and role, needs assessment, principles of utilization review/quality assurance, use of Milliman or other clinical decision support criteria, discharge planning, and reimbursement structures.
- Ability to read, analyze, and comprehend complex clinical data and its application to level of care criteria and discharge options; strong, broad-based clinical knowledge and understanding of pathology/physiology of disease processes; excellent critical thinking skills; assertive personality traits to facilitate ongoing physician communication; organize, prioritize, and manage time efficiently.
Skills and Abilities:
- Computer literacy and familiarity with the operation of basic office equipment.
- Ability to communicate effectively with a wide range of hospital personnel, physicians, patients/family members within various socioeconomic groups, and representatives of varied outside agencies.
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