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Job Type:
RegularScheduled Hours:
20Job Summary:
The Care Coordinator coordinates the integration and provision of services for patients during the ED episode of care. Primary duties include:Models and promotes collaboration and communication among members of the healthcare team, while acting as an advocate for the patient and their families;
Facilitates throughput management.
Readmission prevention management.
Serves as a clinical resource for patient classification assignment, level of care required, and payor requirements/limitations.
Provides initial discharge planning screen, and ongoing patient assessments during the ED visit to assess the patient for potential post-acute needs.
Provides alternate level of care and post discharge planning to ensure care is being provided at the most appropriate level of service/location in line with regulatory and payor requirements.
Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.
Job Description:
Coordinates and Optimizes throughput activities to optimize patient outcomes including:
- Completes thorough chart review upon entry and admission.
- Collaborates with the Logistic Center to assist in Throughput throughout patients hospitalization.
- Participates in ongoing communication with physician and interdisciplinary team to develop a collaborative relationship aimed at improving clinical treatment goals, efficient utilization of services, and appropriate and timely discharge for the patient.
- Educates patients upon admission about their patient class, advance directives and anticipated LOS based upon the geometric length of stay.
- Completes proactive initial patient assessments that holistically screen the patient for potential post- acute needs.
- Maintains active interaction with the patient/family throughout the patients stay in the emergency department.
- Proactively makes appropriate referrals to internal and post-acute service providers to ensure continuity of care during and post hospitalization.
- Provide expertise and support to the treatment team regarding the management of chronic disease/complex patients.
- Provide expertise to the team in developing treatment and discharge planning strategies for frequently admitted patients.
- Assists in the procurement of services and serves as an advocate on behalf of patient/family for scarce resources.
- Maintains high team standards by addressing coordination problems within the functioning of the healthcare team.
- Identifies and escalates any issues that relate to LOS/Throughput/Readmission management.
- Provides to patients, families, and hospital staff education regarding post- acute services (home health services, durable medical equipment, etc.) Opportunities for conducting education may include patient families at bedside, one-on-one staff education, and unit department meetings.
- Provides post discharge follow up calls to all patients who had post- acute services set up for home to ensure patient obtained identified needs.
Upon admission, reviews appropriate/standardized criteria to determine the level of care required for the patient and alternate care delivery options.
- Upon admission, assesses the appropriateness of the level of care/care management; diagnostic testing and clinical procedures; quality and clinical risk issues; and documentation of medical record completeness. Records variances through the established care coordination and quality improvement processes. Documents all reviews in designated software system.
- As appropriate, reviews all patient information within the designated time frame to determine the suitability of the level of care.
- This includes appropriateness of admission and/or continued stay utilizing established nationally recognized criteria.
- Provides educational support regarding utilization management issues.
- Assists in monitoring critical care, telemetry and med/surg bed utilization.
Documents throughput/ discharge planning activities according to departmental policies.
- Completes data collection via designated software for all patients.
- Identifies and documents risk management and quality issues to appropriate departments/services.
- Communicates only appropriate necessary information on chart applicable to the referral source in accordance with HIPPA guidelines.
Maintains knowledge as it applies to utilization management and discharge planning in general and specifically to Medicare, Medicaid guidelines, rules and regulations.
- Attends organizational committees, arriving on time and prepared, and implements/communicates information.
- Engages in educational opportunities to maintain professional competencies.
Interacts with or provides information for third party payors/review agencies to coordinate certification requirements, LOS treatment planning and other benefit utilization issues.
- An established procedure is utilized to resolve denial of care, conflicts over care, service or payment.
- Assists in coordinating pre/post hospital care within SEH, providers, and community health services.
- Coordinates the utilization of benefits and resources in the course of care.
- Works and communicates the plan of care effectively with patient/family; medical staff; caregivers, healthcare team members and third-party payors.
- Works confidently to identify an effective approach to task/problem. Communicates with patient to ensure understanding of discharge planning referrals as ordered by physician and third-party guidelines.
- Assists with negotiation of financial arrangements for reimbursement for out-of-network services.
Performs other duties as assigned.
Education, Credentials, Licenses:
- Graduate of an accredited baccalaureate school of nursing or related field.
- Licensed as an RN to practice nursing in the state where work is being performed.
- Meets contact hour requirements for licensure, including all state required courses.
Specialized Knowledge:
Knowledge of state and federal regulatory issues such as CMS medical necessity, third party payor reimbursement methodologies, contractual obligations, and covered benefits. Working knowledge of SEHC policies and procedures.
Good organization, critical thinking and problem solving skills.
Excellent communication and human relations skills.
Kind and Length of Experience:
2 years experience in acute care
FLSA Status:
ExemptRight Career. Right Here. If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community.
