Clinical Care Coordinator

3 weeks ago

Chicago, Illinois, United States Loretto Hospital Full time
Job Summary

The Clinical Care Coordinator assumes responsibility for assessing and directing the clinical management of patients in specific case groups for an episode of care. This role requires developing and meeting desired patient care outcomes for the caseload based on assessment of patient care needs and established clinical care patterns, within an appropriate length of stay and appropriate use of resources.

Key Responsibilities
  • Conducts initial screening and assessment of patients on admission, including observations using pre-established Intensity of Service and Severity of Illness criteria.
  • Plans, organizes, directs, and evaluates the continuum of patient care in collaboration with physicians and other healthcare professionals.
  • Facilitates the patient's movement throughout the hospital system, coordinating, negotiating, procuring, and managing the plan of care to facilitate cost-effective quality of care and patient satisfaction.
  • Reviews patient records according to established utilization review criteria to ensure appropriateness of hospitalization and communicates with Medicare, Medicaid, and third-party payers to ensure coverage for services.
  • Explores strategies to reduce the length of stay and resource consumption, implements, and documents results.
  • Prioritizes workload and focuses on problem cases, communicating with physicians, nurses, department directors, and other healthcare providers.
  • Documents on worksheets, assessment forms, and progress notes on a timely basis and as per policy.
  • Facilitates appropriate referral consultation based on patient assessment, follow-up of required or delayed testing, care pathway, and results of physician intervention.
  • Coordinates discharge planning, including assessment of discharge needs, resource availability, and communication of patient's needs among team members and families.
  • Identifies and reports any quality, risk management, or utilization issues to the Director of Utilization Review/Case Management.
  • Facilitates and coordinates patient care team conferences, communicating utilization issues, discharge planning reviews, and variances of care.
  • Completes all admission, discharge, and psychosocial assessments on a timely basis and completes monthly statistical logs to reflect case activity.
  • Assists the Director of Utilization Review/Case Management in the investigation of over and underutilization cases, implementation of corrective measures, and chart review per medical staff request.
Compliance Responsibilities
  • Understands and adheres to Loretto Hospital's compliance standards as they appear in the Compliance Policy, Code of Conduct, and Conflict of Interest Policy.
  • Keeps abreast of all pertinent federal, state, and Hospital regulations, laws, and policies as they presently exist and as they change or are modified.
  • Ensures that staff are trained and evaluated on their knowledge of and adherence to compliance policies and procedures specific to their jobs.
Requirements
  • Licensed Nurse with current Illinois license or Bachelor's degree in a Healthcare-related field.
  • Minimum of two years' experience in Medical/Surgical, Psychiatry, and/or Critical Care.
  • At least one to two years' progressive experience in utilization management, discharge planning, or case management.
  • Strong communication skills, utilizes problem-solving process, acts as a team leader, demonstrates good work ethic, demonstrates good nursing assessment skills, maintains confidentiality, demonstrates flexibility, and analytical skills.
  • Has working knowledge of resources available in the community for the patient and families.
  • Has basic knowledge of criteria sets.
  • Demonstrates working knowledge of payer requirements.

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