Care Coordination Specialist

2 months ago

Norwalk, Connecticut, United States Nuvance Health Full time
Job Summary

Nuvance Health is seeking a highly skilled and experienced Clinical Care Coordinator to join our team in the Emergency Department. As a key member of our care coordination team, you will play a vital role in ensuring that patients receive the highest level of care and that their transitions through the healthcare system are smooth and efficient.

Key Responsibilities
  • Manage the utilization review process for patients being considered for hospitalization, ensuring that the correct level of care is assigned and the optimal initial care plan is implemented.
  • Make recommendations for bed requests through thorough review of available clinical information and use of evidence-based screening criteria.
  • Refer cases to physician advisor review as necessary.
  • Collaborate with social work care coordinators to ensure optimal plans of care for discharge.
  • Analyze clinical, financial, and social situations to identify problems and establish alternative courses of action.
  • Perform rounding with members of the ED team to ensure appropriate case identification and planning discussions.
  • Advise and educate patients and families on guidelines pertaining to hospitalization and options for discharge planning.
  • Issue all required regulatory notices as appropriate.
  • Offer suggestions and new ideas for improving performance and operations.
  • Guide, direct, and educate the healthcare team to ensure optimal outcomes.
  • Monitor ED throughput and assist in the facilitation of testing and procedures.
  • Participate in community teams for the management of complex and high-recidivist patients.
  • Ensure the transmission of information through accurate referrals for discharge/transition planning to community providers and accurate hand-off of pertinent information to care coordination colleagues.
  • Collaborate with utilization review specialists to complete the process for transfers into the hospital.
  • Assist with audits and supply data for various metric analysis.
  • Comply with all pertinent standards, regulations, and guidelines.
  • Fulfill all compliance responsibilities related to the position.
Requirements
  • Minimum formal education of Associate Degree in Nursing.
  • Minimum of three years job-related experience.
  • Registered Nurse license in the State of CT with a minimum of one year as an acute care coordinator.
  • Knowledge and expertise with the use of electronic medical records and experience with both Interqual and Milliman screening criteria.
  • Excellent collaboration and team member skills, with the ability to work closely with physicians and all members of the healthcare team.
  • Knowledge and expertise in CMS and insurance industry standards, as well as guidelines pertaining to appropriate coverage notifications.
  • Ability to be flexible, resourceful, and creative in problem-solving.
  • Excellent communication skills, both oral and written.
Preferred Qualifications
  • Certification in Case Management.
  • Bachelor's Degree in Nursing.
Work Environment

Nuvance Health is a network of convenient hospital and outpatient locations, offering a range of healthcare services to the community. As a member of our team, you will have the opportunity to work in a dynamic and fast-paced environment, collaborating with a talented team of healthcare professionals to deliver high-quality patient care.

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