Patient Care Coordinator

2 weeks ago

Oconomowoc, Wisconsin, United States Rogers Behavioral Health Full time

The Patient Care Coordinator plays a pivotal role in overseeing the treatment journey from pre-admission through to discharge. This position is responsible for monitoring the care process for both individual and collective cases, advocating for the best interests of patients and their families while ensuring that Rogers Behavioral Health maintains high standards of care and effective cost management. The Coordinator collaborates across departments to identify and resolve care delivery challenges within the organization.

Key Responsibilities in Patient Care Coordination

  • Serve as the primary contact between Rogers Behavioral Health and external payers, advocating for initial and ongoing medical necessity authorizations. Facilitate utilization information sharing and coordinate physician-to-physician reviews as necessary.
  • Examine active medical records to confirm compliance with medical necessity documentation and escalate any issues related to documentation or quality of care.
  • Engage with utilization review teams, admissions, and clinical leadership to enhance the quality of documentation within medical records.
  • Collaborate with clinical leadership to provide training and education to staff on medical necessity documentation standards.
  • Deliver feedback to clinical teams regarding documentation quality and assist in ongoing training efforts.
  • Work closely with clinicians and admissions staff to enhance their understanding of documentation requirements and medical necessity criteria.
  • Initiate the physician advisory review process as needed.
  • Ensure that all transitions of care to internal treatment programs are adequately covered by acting as the liaison among admissions, clinical teams, managed care, and financial services to secure necessary authorizations.
  • Notify leadership of any sensitive cases that may involve managed care and could lead to contractual arrangements.
  • Collaborate with regulatory and quality departments to identify and address issues that may pose risks to patients or the organization.
Areas of Responsibility
  • Pre-certifications and Admissions: Manage all tasks related to new admissions, ensuring that all patients have current screenings that document medical necessity and complete initial authorization requests with payers.
  • Program Oversight: Assume responsibility for assigned programs, leading multidisciplinary teams to ensure quality care and positive outcomes, conducting concurrent reviews, and maintaining open communication with clinical staff regarding treatment and case management.
  • Floating Responsibilities: Provide coverage for other coordinators as needed, ensuring continuity of care and support.
Process Improvement and Support
  • Assist new coordinators in understanding and adhering to established protocols.
  • Contribute to the development and implementation of new standard operating procedures by identifying inefficiencies and collaborating on solutions.
  • Support data collection efforts to promote continuous improvement initiatives.
Communication and Customer Service
  • Maintain ongoing communication with clinical teams and admissions regarding case statuses.
  • Assist financial services in resolving reimbursement issues.
  • Educate patients and families about insurance benefits, authorizations, and potential costs associated with care.
  • Foster positive relationships with managed care organizations.
Commitment to Organizational Goals
  • Communicate departmental goals to team members and demonstrate measurable achievements.
  • Adhere to departmental policies and procedures, incorporating guidelines from external regulatory agencies.
  • Educate new staff on relevant regulations and requirements.
Qualifications:
  • A Bachelor's Degree is required, preferably in Behavioral Science.
  • At least two years of experience in an office or healthcare setting is preferred.
  • Familiarity with managed care, Medicaid, and Medicare processes is essential.
  • Experience in utilization review within a healthcare or managed care environment is advantageous.
  • Knowledge of diagnostic criteria and treatment processes in mental health and substance use disorders is required.
  • Proficient computer skills, including word processing and data management, are necessary.
  • Understanding of documentation standards set by regulatory bodies is important.

At Rogers Behavioral Health, we offer a comprehensive benefits package, including health, dental, and vision insurance, a 401(k) retirement plan, employee share program, life and disability insurance, flexible spending accounts, tuition reimbursement, wellness programs, and an employee assistance program.

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