Clinical Care Coordinator
2 weeks ago
Department/Unit: Radiology Support Services
Work Shift: Day (United States of America)
Salary: Salary Range: $65,057-$107,343.00, commensurate with experience.
The Clinical Care Coordinator is responsible for leading the interdisciplinary team to plan, coordinate, implement, and assess patient care for the designated service line throughout the care continuum. This role involves proactive collaboration with Quality Improvement Teams, adherence to patient care standards, and effective utilization management to ensure optimal clinical and financial outcomes. The Clinical Care Coordinator plays a vital role in maintaining quality care and driving performance improvement through leadership, problem-solving, decision-making, and outcome measurement. Acting as a resource for the healthcare team, community, patients, and their families, this position encompasses the roles of clinician, consultant, advocate, and educator.
Key Responsibilities:
- Assist the admission physician and interdisciplinary teams in ensuring coordinated care throughout the hospital stay, both pre and post-operation.
- Proactively monitor patients' clinical processes using established care standards and evidence-based guidelines to guarantee timely and appropriate interventions that achieve optimal patient outcomes while adhering to financial constraints.
- Collaborate with the primary nurse to assess discharge planning needs, coordinate necessary resources, and evaluate the effectiveness of the discharge plan, initiating this process upon admission.
- Work alongside the healthcare team and relevant departments to manage care across the continuum, including pre-admission, discharge, post-discharge, planning length of stay, and resource utilization.
- Utilize specialized knowledge and evidence-based guidelines to provide leadership and guidance in formulating individualized multidisciplinary care plans that encompass pre-hospitalization, acute care, discharge education, transitions to home, and community resource utilization.
- Facilitate and participate in care conferences for patients with complex needs.
- Support patient and family education and the discharge process to promote continuity of care and optimal outcomes.
- Demonstrate proficiency in the referral process and the use of community resources.
- Review admission screening data to clarify diagnoses, establish appropriate lengths of stay, and identify potential outliers, ensuring adherence to institutional standards and evidence-based guidelines.
- Engage with payer sources to confirm and negotiate benefits and conduct concurrent reviews.
- Identify capitated patients to determine appropriate service utilization and coordinate post-hospital care using defined standards.
- Recognize high-risk patients based on clinical and financial criteria for collaboration with financial services to address available resources.
- Ensure all medical/legal documentation is accurately maintained in patient records.
- Comply with regulations set by third-party payers, including notices of non-coverage reinstatement and continued stay.
- Collaborate with the healthcare team to implement strategies aimed at reducing length of stay and resource consumption to optimize patient health status.
- Assess educational needs and provide learning opportunities for healthcare professionals relevant to specific cases and patient care groups.
- Work with case management leadership to compile and report aggregate variances and data for specific patient care services.
- Communicate and analyze aggregate variances with healthcare team members, developing strategies for variance reduction.
- Bachelor's Degree - required
- Master's Degree - preferred
- 1-3 years of clinical experience in an assigned service - required
- Recent experience in case management, utilization management, and/or discharge planning in a high-volume acute care setting - preferred
- Demonstrated effective communication, facilitation, and organizational skills.
- Assertive and creative in problem-solving, critical thinking, systems planning, and patient care management.
- Self-directed with the ability to adapt in a dynamic environment.
- Basic knowledge of computer systems relevant to the utilization review process.
- RN - Registered Nurse - State Licensure and/or Compact State Licensure Upon Hire - required
- Certified Case Manager and PRI Upon Hire - preferred
- Standing - Constantly
- Walking - Constantly
- Sitting - Rarely
- Lifting - Frequently
- Carrying - Frequently
- Pushing - Occasionally
- Pulling - Occasionally
- Climbing - Occasionally
- Balancing - Occasionally
- Stooping - Frequently
- Kneeling - Frequently
- Crouching - Frequently
- Crawling - Occasionally
- Reaching - Frequently
- Handling - Frequently
- Grasping - Frequently
- Feeling - Constantly
- Talking - Constantly
- Hearing - Constantly
- Repetitive Motions - Constantly
- Eye/Hand/Foot Coordination - Constantly
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