Acute Care Coordinator

3 days ago


Oakland, California, United States Talent Software Services Full time
Job Summary:

This role is responsible for coordinating the utilization management, resource management, discharge planning, post-acute care referrals, and care facilitation for acute patient populations. The ideal candidate will oversee the management of acute patient populations across the care continuum, focusing on providing coordinated and integrated care to prevent unnecessary admissions or readmissions.

Key Responsibilities:

• Conduct initial and concurrent screenings to determine moderate or high-risk levels for readmission.
• Functionally supervise and lead the healthcare team in developing comprehensive, cost-effective care coordination plans that meet the clinical needs of patients.
• Formulate transition plans after reviewing available/appropriate care options and obtaining input from patients/families, physicians, healthcare teams, payers, and community-based support services.
• Identify and refer quality and risk management concerns to appropriate levels for corrective action plans and trending.
• Direct and oversee assistants in interviewing patients/families to determine preferences for post-acute care services.
• Complete initial InterQual review screenings upon admission for all patients placed in hospital beds and document inpatient or observation status.
• Perform InterQual continued stay and discharge planning reviews.
• Review medical records daily to ensure patients continue to meet level of care requirements and chart documentation supports LOC determination and assignment.
• Collaborate with Physician Advisors and Attending Physicians to obtain necessary documentation to support current LOC, alter LOC as needed, and expedite discharge planning for patients who no longer require hospital services.
• Monitor Length of Stay (LOS) and outliers requiring additional resources and/or focus and report to management.
• Collaborate with financial counselors for delivery of inpatient stay denials.
• Ensure delivery of Medicare Important Message within 48 hours of discharge and no less than 4 hours of actual discharge.
• Actively participate in patient rounds following standard work as developed and collaborate with interdisciplinary teams to assure timely discharge.
• Maintain an average Utilization Review (UR) accuracy rate at or above the goal.
• Utilize InterQual criteria for potential/actual admissions to determine appropriateness of admission, setting, and level of care.
• Follow policies and procedures for Physician Advisor referrals.
• Facilitate and expedite discharge of patients from the Emergency Department (ED) to alternate care settings.
• Consistently document in the Electronic Health Record (EHR) and other electronic software.
• Maintain current knowledge of medical facility and Joint Commission discharge requirements.
• Initiate timely communication with ED/admitting physicians when medical necessity deficiencies are identified for level of care ordered.
• Identify avoidable admissions and escalate as appropriate.

Care Coordination/Care Transitions:

• Perform initial screenings on all hospitalized patients upon admission to identify case management needs.
• Perform, document, and communicate assessment findings to healthcare teams.
• Screen 30-day readmissions; review previous hospital records, confer with interdisciplinary teams on discharge plans.
• Proactively identify barriers to discharge and work with multi-disciplinary teams to expedite care, monitor Length of Stay (LOS), and facilitate discharge.
• Address complex clinical and social situations efficiently to avoid unnecessary delays in discharge.
• Complete treatment plans and transition plans.

Certifications:
  • CA RN License
  • BLS
  • CLS
Preferred:
  • RN Case Manager with acute hospital discharge planning experience; inpatient acute rehabilitation preferred.
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