Care Coordinator, ED

About the Role

The Care Coordinator is responsible for the achievement of optimal health for the patient, access to care, and appropriate utilization of resources. The patient’s plan of care will be balanced with their right to self-determination and patient/caregiver choice. The Care Coordinator, with respect to payer requirements, will ensure timely notification and communication of pertinent clinical data to support admission, clinical condition, continued stay, and authorization of post-acute services.

Schedule

Two 8-hour shifts and two 12-hour shifts a week.

Responsibilities

• Assess patients for clinical, psychosocial, financial, and operational factors that may affect the progression of care.
• Stratify patients at risk for over-utilization of services and/or in need of care coordination services.
• Collaborate with the clinical team to reduce inpatient length of stay and readmissions across the organization.
• Perform and document appropriate admission and continued stay reviews using current InterQual/Milliman Care Guidelines criteria on assigned patients.
• Develop an effective transition plan based on the health care team's assessment, patient choice, and available resources.
• Actively participate in CTR rounds; interpret and integrate the patient’s story into the overall multidisciplinary plan of care.
• Develop and implement corrective action plans for resolution of complex problematic issues and elevate to management as necessary.
• Document information that is complementary and contributes to the progression of the plan of care, avoiding duplication.
• Collaborate with the Physician Advisor for complex issues related to the medical plan of care.
• Actively participate in clinical performance improvement activities as assigned.
• Remain current on clinical practice and protocols impacting clinical reimbursement.

Qualifications

• Graduate of an approved registered nursing program with a current RN license in the State of Maryland.
• Three years of experience in an acute care hospital.
• Experience in case management and/or utilization management preferred.
• Demonstrated excellent verbal and written communication, interpersonal, and organizational skills.
• Ability to demonstrate knowledge and skills necessary to provide care based on the age of the patients served, including understanding principles of growth and development over the life span.