Coord Patient Care Utilization

Coordinator Patient Care Utilization Condell Medical Center FT Days Provides day-to-day activities of Care Management staff by balancing workloads, providing leadership within the department, and providing consultation to staff in collaboration with the Manager of Care Management/Social Services.
Provides and facilitates the provision of care coordination services for health care related situations for patients and their families taking into consideration both the patient/family needs, available resources and the mission and philosophy of the organization and its affiliates.
Responsible for staff education via onboarding/orientation; provision of training and assessment of proficiency for new tasks, systems, and processes; evaluates and reinforces quality care via ongoing audits and feedback.
MAJOR RESPONSIBILITIES Conducts complete assessments, establishes appropriate plans, and initiates timely interventions.
Collaborates and negotiates effectively with patient, family and team while striving to achieve patient and organizational goals regarding patient’s care needs, choice, and satisfaction when discharge planning/transitioning care.
Works as a member of the multi-disciplinary care team in a collaborative and proactive manner to promote best practice.
Conducts concurrent and retrospective clinical review based upon pre-established criteria approved by the medical staff for admission appropriateness and avoidable day(s) surveillance.
Provides clinical updates for the purpose of obtaining certification to third party payers and fourth party external review groups, as stipulated in contractual agreements.
Refers cases to physician advisor as needed to ensure accurate status and compliance with regulatory guidelines.
Collects accurate data on outcomes and resource utilization issues and facilitates reporting of utilization monitoring/review activities to the appropriate committees/persons.
Serves as an expert user of information technology platforms that support care management.
Assists Manager with Human Resource responsibilities for staff which include interviewing and selecting new employees, promotions, staff development, performance evaluations, pay adjustments, resolution of employee concerns, disciplinary counseling, terminations, and employee morale.
Provides general work direction and guidance to case managers.
Serves as an educator and resource to staff regarding utilization issues, regulatory requirements, department policies and procedures.
Collaborates with management in the development of new programs/services and updating current programs/services.
Assists in the internal management of Care Management including assigning, assessing and overseeing staff caseloads in collaboration with the leader.
Serves as liaison with physicians to address utilization management and care coordination issues.
Monitors assigned area for efficient use of supplies and equipment.
Determines appropriate clinical equipment needs and follows through on approvals, purchase and repairs as needed.
Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served.
Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department’s.
License/Registration/Certification Required: Registered Nurse license issued by the state of practice and Accredited Care Manager (ACM) certification issued by the American Case Management Association (ACMA) needs to be obtained within 1 year, or Care Manager Certified (CMC) certification issued by the National Academy of Certified Care Managers (NACCM) needs to be obtained within 1 year, or Nurse Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within 1 year Education Required : Bachelor’s Degree in Nursing.
Experience Required : Typically requires 5 years of experience in care management for a large, complex health care organization that includes experiences in an acute care setting.
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED Excellent oral and written communication skills.
Interpersonal skills are essential to negotiate with patients, families, physicians, community agencies and third-party payers for an optimum plan of care.
Intermediate computer skills including word processing, presentation applications and electronic mail.
Electronic medical record systems experience preferred.
Demonstrated leadership skills in diplomacy, human relations, building rapport, collaboration, organization, prioritization, and promotion of staff development.
PHYSICAL REQUIREMENTS AND WORKING CONDITIONS Must be able to sit up to approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time.
Must lift up to 10 lbs.
continuously, up to 20 lbs.
frequently, and up to 50 lbs.
occasionally.
Manual dexterity required for operation computer and calculator.
Visual acuity required for facilitating review of written documents/computer screens, medical records, and to record information accurately.
Clear verbal communications and hearing acuity required for receiving instructions and converse on standard telephone.
Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.
Exposed to normal office environment; including usual hazards related to operating electrical equipment.
Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent.
It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent.
Incumbent may be required to perform other related duties.