Clinical Care Coordinator-Unit Specialist
1 week ago
The Clinical Care Coordinator - Unit is a key member of the healthcare team, responsible for ensuring the efficient progression of patient care and effective discharge planning. This role requires strong clinical knowledge, excellent communication skills, and the ability to work collaboratively with various stakeholders.
Key Responsibilities- Coordinates and directs the level of care appropriateness from admission to discharge, ensuring that patients receive the right level of care and services.
- Uses discretion and independent judgment to apply initial screening criteria standards and maintain compliance with payer regulations.
- Prioritizes and delegates daily functions to ensure completion of all required tasks, including coordinating ambulance and DME services.
- Completes planning using high-risk admission data and discharge criteria, anticipating medical and psychosocial needs in high-risk patients.
- Collaborates with Social Workers and Care Coordination Assistants to manage elements of case and meet administrative needs.
- Manages level of care status throughout the stay, performing continued stay reviews, removing barriers to progression of care, and revising transition plans as needed.
- Ensures all appropriate regulatory documents are provided to patients, including MOON, CT notice, IMM, HINN, and ABN.
- Ensures the completion of a discharge needs assessment and formulation of a plan on all admissions, using appropriate resources such as CARL tool for bundled payment cases and Navihealth.
- Acts as a clinical role model to the healthcare team, leading and facilitating multidisciplinary rounds to proactively progress patient plans of care and discharge.
- Addresses readmission prevention strategies and LOS concerns, querying members of the healthcare team to obtain accurate and complete documentation.
- Coordinates and collaborates to ensure the implementation of all discharge plans, meeting and acting on cases not meeting admission criteria, and referring to physician advisors all cases requiring immediate review and discussion.
- Proactively interacts with third-party payers to prevent denials, acting as a liaison between patients, physicians, families, and healthcare teams regarding plans of care and progress towards goals.
- Provides education to physicians, nurses, and other members of the healthcare team, providing a concise hand-off to colleagues daily.
- Tracks and trends variance data, elevating concerns and findings to management, complying with all standards and policies regarding safety and patient safety initiatives.
- 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 both Interqual and Milliman screening criteria.
- Excellent collaborator and team member who can work closely with physicians and all members of the healthcare team to procure the right level of care, correct order for hospitalization, optimal plan of care, and facilitation of services.
- Knowledge and expertise in both 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.
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