Care Coordinator Specialist-Weekend Hospital

4 days ago

Durham, North Carolina, United States Duke University Full time
Care Coordinator Specialist-Weekend Hospital

Duke University's Connected Care initiative is a community-based, physician-led network that brings together doctors, hospitals, and other healthcare providers to deliver high-quality care to Medicare Fee-for-Service patients in Durham and surrounding areas.

This role is part of a team that performs a variety of specialized, complex activities in the coordination of post-acute care services. The successful candidate will have strong organizational skills, excellent investigative and analytical skills, and the ability to work calmly and efficiently in high-pressure situations.

Key Responsibilities:

  • Coordinate post-acute care services, including durable medical equipment, home health, facility placement, dialysis, outpatient appointments, and transportation.
  • Review discharge planning forms for completeness, timing, and conformity to policy and guidelines.
  • Deliver the Important Message from Medicare according to CMS guidelines to all indicated patients based on case manager's noted expected discharge date.
  • Participate in daily Case Management touchpoints with Case Managers, Social Workers, and Utilization Managers.
  • Discuss referred cases, including patient status, barriers to discharge, payer communication, expected discharge date, transition planning priorities, escalations, and support needed.
  • Regularly evaluate work lists and re-prioritize items for the day.
  • Escalate more complex inquiries and barriers to the appropriate resource.
  • Stay in close contact with the requester to alert Case Management Staff of barriers to completion of needed tasks, provide status updates, and ultimately share details of case completion.
  • Enter appropriate documentation of all discharge planning activities and communications according to department standards and closely monitor pending tasks and priority levels of each task.
  • Maintain strong working relationships with both internal Duke staff and external agency staff, such as post-acute liaisons, admissions coordinators, medical providers, and staff in community-based organizations, to ensure timely, appropriate, and safe transitions of care.
  • Obtain all authorizations for SNF care, both by utilizing the NaviHealth portal for payers who utilize that system as well as any other processes used by all other managed care and health plans.
  • Schedule peer-to-peer reviews for Physician Advisors (PAs) and communicate electronically to the PAs the dates/times and contact names/numbers of the payer's Medical Director with whom they will be speaking.
  • Discuss rationales for initial denial of services with the PAs to assist in their preparation for the peer-to-peer discussion.
  • Meticulous record keeping of this process will be expected as data will be needed to assess volume for future expansion.

Requirements:

  • Associate's degree in business, healthcare administration, social work, or a related healthcare field.
  • Bachelor's degree in business, healthcare administration, social work, or a related healthcare field highly preferred.
  • 2 years of related experience required.
  • A Bachelor's degree in a related field can substitute for the experience requirement.

Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

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