Transitional Care Coordinator

POSITION SUMMARY:

Wage range: $26.39/hr - $37.21/hr

Coordinates department phone, patient transportation, patient follow-up appointments, obtaining external patient records, insurance authorization and general support of the department employees.

KEY RESPONSIBILITIES

Performed majority of the time:

• Aids Case Management clinical team members in securing necessary post-acute care, DME, community resources and transportation for the various discharge needs of patients.
• First Line employee for department phones, receives, screens and triages calls in conjunction with the Discharge Coordinator.
• Coordinates communication with physicians, clinics, community resources, patients and Case Managers regarding the continuum of care according to determined care plans.
• Audits and maintains compliance with Medicare required notices including IMM and MOON including notice delivery to patients.
• Schedules follow up appointments, new patient PCP appointments, and Specialty follow up appointments.
• Creates Discharge Packets for patients going to another level of care following discharge.
• Facilitates referrals for home health care, hospice, medical equipment and supplies and transfer to other facilities as appropriate.
• Collaborates with patients, families, physicians, nurses, and other health care professionals to facilitate post-hospitalization health care services.
• Provides resources for families regarding community resources, area agencies, and Medicare Certified Post-Acute Providers when needed.
• Assists in securing prior authorization from patient’s insurance provider for transition to level of care as deemed clinically appropriate to meet level of care needs.
• Facilitates Authorization for some outpatient procedures and services after discharge
• Facilitates the timely discharge of patients from the hospital setting from the Transitional Care Coordinator role perspective.
• Facilitates notification to outside agencies regarding patient hospitalization (Kaiser, VA)
• Follows up post discharge to ensure post-acute providers have received appropriate referrals, and discharge summaries.
• Documents relevant discharge planning information in EMR according to department standards including all services arranged, referrals and continuous updates.
• Arrange or identify follow up appointments post-discharge including new, PCP, Specialties, lab, radiology etc. to prevent hospital readmissions.
• Provides motivated assistance in admissions, transfers, and discharges of patients managed by Case Management.
• Facilitates delivery of DME to bedside on short-stay patients.
• Follow up with any services arranged such as referrals/insurance companies to ensure resources are obtained.
• Assists in the collection and reporting of resource and financial indicators including, delays, resource utilization, denials and appeals. Supports continuous improvement in these areas.
• Arranges patient transportation at the direction of clinical staff.
• Consults with the social worker to identify appropriate social service needs, and help facilitate referrals to appropriate outpatient services.
• Relates pertinent information to Case Management Manager to escalate appropriately and represent to medical committees, nursing staff, and ancillary provider staff as appropriate.
• Maintains Department Reporting/Auditing as directed by Case Management Manager

• Reviews Admitting/IVS comments in EMR, approved length of stay, clinical review due date, and insurance company UR contact information in Payer Communication of EMR to minimize miscommunication when coordinating resources
• Calls appropriate inside or outside personnel to locate missing authorization numbers, approved length of stay, clinical review due date, and insurance company UR contact information to ensure resources are covered for post-acute coordination
• Collects and organizes data related to clinical condition and treatment plan for use in utilization review by communicating with insurance providers. If denied, collaborates with treatment team to create a new plan.
• Faxes clinical information to third party payers, when allowed by payer, in order to obtain authorization for continued stay and discharge resources.
• Notified Case Manager when phoned clinical information is required otherwise, resources are determined and coordinated based on coverage.

Performed occasionally but critical to successful performance of the job:

• Attends scheduled department meetings.
• Maintains up-to-date working knowledge and functional use of Medicare rules and commercial payer rules.

Decision making and budget responsibilities (e.g. impact limited to the employee, entire unit or organization-wide):

• Decisions can impact the operations of the entire unit.
• Supports the manager with data for budget planning.

JOB SPECIFICATIONS:

JOB SPECIFICATIONS

Education:

• N/A

• Bachelor’s degree in a healthcare related field.

Experience:

• Two (2) years healthcare delivery system related experience.

• Discharge planning, utilization review, case management or healthcare insurance experience.

Licenses, Certifications and/or Registrations:

• N/A

• Current Oregon license as an LPN, C.N.A. II or Medical Assistant.

Job Related Skills, Abilities and Behaviors:

• Advocates and respects patients’ rights and/or significant other’s rights.
• Utilizes conflict resolution skills as necessary to ensure timely resolution of issues.
• Collaborates with multidisciplinary care team to eliminate barriers to efficient delivery of care in the appropriate setting.
• Demonstrates an understanding of insurance payor language and various health care options.
• Utilizes problem-solving techniques consistently to resolve complaints or concerns.
• Demonstrates respect of others, communicates clearly and attempts to resolve interpersonal conflicts.
• Develops and maintain collegial relationships with other professionals by attending continuing education and professional group sessions.
• Demonstrated ethical commitment to quality assurance and confidentiality of all data and information, including HIPPA/PHI.
• Excellent customer service, verbal/written communication and interpersonal relations skills to respectfully serve customers of diverse backgrounds and preferences. This includes the skills to obtain and interpret information appropriate to patients' needs, age, etc. as required for assessment, range of treatment and patient care.
• Familiar with computer word processing, database and spreadsheet programs.
• Demonstrated ability to take initiative, implement and follow through with attention to detail, with minimal supervision.
• Creative problem-solver, solution-oriented, able to stay flexible and professional under the pressure of multiple demands.
• Acts as a team member and supports the success of others.
• Works collaboratively and maintains active communication with the multi-disciplinary care team to effect timely, appropriate patient management.
• Proactively identifies and resolves delays and obstacles to discharge.
• Collaborates, communicates with, and provides support to the multidisciplinary team through all phases of the discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, and ongoing evaluation.
• Collaborates/communicates with external case managers and community services.
• Demonstrates confidentiality according to PHI regarding patient and co-worker information.

• Knowledge of community health and social service resources.
• Bilingual skills a plus.

We further commit ourselves to continuing the practical application of this policy in our daily business conduct.