Location: Charleston, WV
Job Description: Full time position
The Care Coordinator (CC) plays an integral role in the member’s journey towards better well-being by serving as the communication link between members and appropriate health care personnel. The Care Coordinator is responsible for identifying the appropriate Post-Acute Care (PAC) setting insuring efficient, smooth, and prompt health care services will be delivered to the member. They engage both the member and their relatives while providing objective informationand supportthroughout the care continuum.
- Perform functional assessments of members using clinical skills and appropriate measurement tools. Provide outcomes targets to appropriate audience.
- Utilizes proprietary technology for consideration of level of care.
- Maintains UM/CM tool
- Collaborate effectively with the member’s health care team to establish an optimal, transition plan to the most appropriate PAC setting. The health care team includes physicians, health plan UM/CM Nurse, hospital discharge planners, referral coordinators, etc.
- Assist the member in meeting short and long-term goals with regards to their overall well-being.
- Consult with Medical Directors and/or management to resolve any barriers in the patient’s movement along the continuum of care.
- Assess and monitor patient’s appropriateness for care setting (as indicated) according to LiveSafe™ and InterQual criteria for approvals and refer to licensed physicians for next level of care determinations that do not meet criteria to be approved.
- Complete Utilization Management functions for authorizations.
- Coordinate comprehensive post discharge health care and referrals for community based services.
- Advise member for appropriate care coordination. Obtains additional services, as indicated.
- Daily review of census and identification of barriers to manage independent workload and ability to assist others.
- Review monthly readmission reports, quarterly and other reports as needed to assist with the identification of opportunities for improvement.
- Participate in weekly patient rounds.
- Adhere to organizational and departmental policies and procedures.
- Maintains confidentiality of all PHI information in compliance with HIPPA, federal and state regulations and laws.
- Registered Nurse with current licensure preferred. Will consider Physical Therapist (PT), Occupational Therapist (OT), or other related field.
- Current active unrestricted clinical license required
- 5 years of clinical experience.
- Case Management experience with CCM preferred.
- Patient education background, rehabilitation, SNF and/or home health nursing experience a plus.
- Experience working with geriatric population preferred.
- CMS and managed care knowledge preferred.
- Excellent documentation skills required.
- Self-starter with the ability to prioritize daily work load.
- Strong interpersonal and communication skills (both verbal and written).