Clinical Case Coordinator RN or SW
2 weeks ago
The Clinical Case Coordinator is accountable for executing the Case Management framework. This role involves overseeing physician documentation and collaborating closely with medical personnel to ensure the appropriateness of hospital admissions. The coordinator identifies and assesses the quality of care, infection control measures, safety risks, potential liability issues, and utilization challenges. Findings are reported to the Director for distribution to relevant departments and committees. The position entails conducting initial utilization assessments and ongoing reviews until discharge. The coordinator identifies discharge and transition requirements and is ultimately responsible for orchestrating discharge planning activities. Collaboration with interdisciplinary teams, both within and outside the organization, is essential. Participation in quality enhancement and evaluation initiatives is also expected.
Key Responsibilities
The successful candidate will be expected to perform the following essential duties:
- Uphold professional ethics by maintaining confidentiality regarding personal, financial, medical, or employment information of patients, families, and staff.
- Adhere to and enforce established safety protocols for patients and the organization.
- Report hazards and take appropriate action as necessary.
- Engage in safety training programs.
- Conduct patient rounds with and without physicians to discuss patient needs.
- Review medical records daily to complete utilization assessments, documenting admission justifications and ongoing care plans.
- Facilitate cooperation among facilities to ensure comprehensive care delivery and address psychosocial needs for case resolution.
- Interview patients, family members, and significant others to summarize immediate comfort levels and identify barriers to care delivery.
- Act as a liaison between patients, families, and hospital staff during critical situations.
- Communicate with nursing and medical teams to assess patients' psychosocial needs and oversee discharge plans.
- Discuss discharge requirements and any obstacles with patients, families, and significant others to ensure safe discharge goals.
- Maintain up-to-date knowledge of regulatory standards including JCAHO, COBRA, EMTALA, and OSHA.
- Ensure accurate documentation in patients' medical records.
- Collect and maintain accurate data related to the quality of care provided by the department.
- Stay informed about and update community resources relevant to practice areas.
- Verify arrangements for homebound education for school-age minors and initiate necessary actions.
- Participate in reporting suspected abuse or neglect as per hospital protocols and notify appropriate agencies.
- Contact attending physicians as needed to ensure that medical documentation meets quality and discharge criteria.
- Assume responsibility for accurate discharge disposition coding in medical records.
- Communicate with attending physicians to ensure documentation reflects the patient's acuity for appropriate reimbursement.
- Engage with attending physicians to clarify medical information and discharge plans, identifying potential needs.
- Inform the Director of Case Management about potential denials.
- Collaborate with the Director of Case Management and refer complex cases to the Physician Advisor.
- Coordinate services required by patients post-discharge, such as skilled nursing facilities, nursing homes, or home health care.
- Refer patients with specific financial needs to the appropriate financial personnel.
- Perform additional tasks as assigned by the Director.
- Participate in relevant educational programs as available.
- Attend and contribute to monthly departmental staff meetings.
- Carry out other responsibilities as assigned.
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