Clinical Care Coordinator

Evaluates and assesses patients admitted to the hospital.

Responsibilities

• Performs concurrent review on all patients and shares all problematic cases with the Supervisor and Physician Advisor.
• Determines and makes appropriate referrals concerning alternate level of care.
• Processes adverse determination decisions to the Physician Advisor and distributes notifications, as appropriate.
• Identifies problematic care patterns or cases and makes referrals to the Supervisor and the department involved.
• Performs retrospective reviews as required.
• Participates in the maintenance of Utilization Management, Discharge Planning and Case Management statistics as required.
• Keeps abreast of all changes in policies and procedures relating to Utilization Management, Discharge Planning and Case Management processes.
• Attends Utilization Management Committee and other staff meetings, as required.
• Participates, as required, in Alternate Level of Care (ALC) meetings.
• Participates in Interdisciplinary Patient Care Rounds.
• Identifies services or treatments that may not be medically necessary and makes referrals to the Physician Advisor.
• Consults with physicians and other health‑care professionals on aspects of patient care.
• Makes referrals to other hospital departments for collaboration and assistance in discharge planning.
• Implements a discharge plan as necessary; documents ongoing discharge planning activities in the patient’s medical record according to protocol.
• Schedules family/patient conferences with the interdisciplinary team, as needed, to assist in coordinating a safe and timely discharge plan.
• Collaborates with appropriate professional personnel to assess patients for alternative level of care and notifies appropriate hospital departments.
• Refers patients who require institutional placement to the Social Work Department for follow‑up and action.
• Acts as a liaison with the patient’s insurance carrier (case manager, utilization reviewer) to coordinate post‑hospital services and referrals.
• Makes arrangements for non‑North Shore‑Long Island Jewish Home Care services, including home care, hospice, equipment, supplies and laboratory services for post‑discharge needs.
• Arranges for the patient’s post‑hospital needs such as visiting nurse, physical therapy, medical/social model day care, personal care aides, long‑term home health care programs, home health aides, private hire, and DME (equipment, supplies, and respiratory needs).
• Assists in identifying patient incidents through the NYPORTS program.
• Performs any and all related duties as required.
• Performs Clinical Care Coordination assessment within 72 hours of admission on all patients; performs ongoing reviews every 48 hours or as necessary.
• Communicates with physicians to obtain clarification of documentation to justify severity of illness, intensity of service and quality of patient care.
• Keeps abreast of all changes in Medicare, Medicaid, and commercial insurances as they relate to clinical documentation, utilization management, and case management processes.
• Shares all problematic cases with the Supervisor of CM‑CCC.
• Identifies problematic documentation patterns or cases and makes referrals to the appropriate departments, the Supervisor of CM‑CCC, and/or the Physician Advisor.
• ADA Essential Function.

Qualifications

• Graduate from an accredited School of Nursing; Bachelor’s degree in nursing preferred.
• Must be enrolled in an accredited program within 24 months of employment (if hired after September 1, 2010) and obtain a BSN degree within five years of employment date.
• Current license to practice as a Registered Professional Nurse in New York State.
• Minimum of two years medical/surgical experience in an acute‑care hospital.
• Experience in utilization management/discharge planning preferred.