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Patient Care Coordinator
2 months ago
Position Overview
Under the general guidance of the Case Management Manager, the Case Manager serves as a dedicated advocate for clients at South Shore Health. This independent role involves coordinating, negotiating, and securing services and resources for complex patients, ensuring the delivery of high-quality and cost-effective healthcare outcomes. The Case Manager actively seeks opportunities to minimize costs while maintaining superior care standards.
Key Responsibilities
- Clinical Review: Conduct thorough reviews of medical records for all observation and inpatient admissions to ensure appropriate care delivery and utilization.
- Medical Necessity Assessment: Utilize Interqual Criteria and collaborate with physicians to determine the necessity for observation, admission, and continued stays.
- Documentation Improvement: Identify cases that do not meet criteria and refer them for secondary review, ensuring adequate documentation is provided to support medical necessity.
- Insurance Coordination: Communicate with attending physicians regarding cases lacking sufficient documentation and notify them of decisions related to insurance coverage.
- Continued Care Review: Monitor patients regularly to assess the need for ongoing hospitalization based on third-party payer guidelines.
- Observation Status Management: Identify and review observation patients daily to ensure correct patient care levels and facilitate timely discharges.
- Transition Planning: Collaborate with physicians to identify potential transition planning issues and establish necessary services.
- Discharge Planning: Work with the Case Manager Specialist to implement safe and timely discharge plans, addressing barriers proactively.
- Interdisciplinary Collaboration: Engage with multidisciplinary teams to enhance communication and optimize resource utilization.
- Referral Processing: Ensure timely processing of referrals for continuum of care providers, documenting patient and family preferences.
Essential Skills
Critical thinking, effective communication, and a proactive approach to problem-solving are vital in this role. The Case Manager must maintain a strong focus on patient-centered care while navigating complex healthcare systems to ensure optimal outcomes for patients and their families.
Work Schedule
This position requires availability on weekends and holidays, with a rotation to ensure continuous patient support.
