UI Health - Healthcare Utilization Review Coordinator II (Patient Care Coordinator)

About the role

The Patient Care Coordinator (PCC) is accountable for coordinating and facilitating patient services across the various levels of the care continuum for a population of patients. The PCC assists patients and their families in navigating through the health care system based on individual and patient population needs. The PCC serves as a role model in promoting interdisciplinary collaboration, teamwork and service excellence.

Responsibilities

• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during the assessment.
• Promotes and coordinates optimum healthcare services, with cost effective solution.
• Implements care plan by facilitating authorizations/referrals as appropriate within the patients benefit structure or through extra-contractual arrangements in conjunction with care team.
• Reduces avoidable hospital admissions, readmissions and ER visits in conjunction with care team.
• Identifies and communicates a self-management plan specifically developed to assist with the improvement of self-monitoring and symptom identification.
• Affirms patients’ healthcare needs and identifies community resources.
• Empowers patients to identify changes in health status and recognize the need to notify their physician of changes.
• Collaborates with hospital staff, physicians, patients, family, insurance carrier, medical office staff, customers and facilities to assess the patient’s healthcare needs and assure appropriate safe, cost effective, timely and efficient services.
• Utilizes clinical and social work experts as needed to ensure delivery of comprehensive patient services.
• Facilitates daily communication with the interdisciplinary team to discuss plan of care and assist with expediting care across the continuum, including participating in daily huddles and communicating to the Care Team or PCP any patient issue that will enhance the office visit.
• Identifies service delivery problems and potential for effective care management intervention.
• Affords assistance in identifying system problems and issues that impede (impeding) diagnostic or treatment progression to the appropriate administrative liaison.
• Collaborates with the interdisciplinary team when delays occur in consults, treatments, discharge planning, or procedures to facilitate timely, cost-effective delivery of patient services.
• PRACTICES IN ACCORDANCE WITH APPLICABLE LAWS AND STANDARDS, AND ETHICAL PRINCIPLES.
• Provides interventions including the following: meeting patients on site; post-discharge contact; conducts assessments of health risk, needs, and health literacy; conducting post-discharge follow-up contact, directly connecting patients to support services such as transportation to resolve barriers to access, and routinely communicating with other members of the interdisciplinary care team.
• Maintains professional license in active and current status.
• Maintains expertise through participation in continuing education programs.
• Serves as experienced resource and patient services facilitation reference for care team members.
• Reviews and provides input into policies and procedures related to continuum of care and patient services facilitation.
• Advocates for patients, families, and their significant others, the community, and the nursing profession.
• Integrates theoretical knowledge, evidence-based research, current standards of practice and clinical experience to provide “quality” patient care as measured by established nursing quality standards and other governing/accrediting health care bodies.
• Performs other related duties and participates in special projects as assigned.

Qualifications

• Graduation from an accredited professional nursing program.
• Current licensure as a Registered Professional Nurse with the Illinois Department of Financial and Professional Regulation, Division of Professional Regulation.
• Five years (60 months) of Medical Surgical experience.
• BSN (or higher) required of an accredited nursing program.
• Current BLS/CPR and/or other required unit specific certifications.
• Minimum of two (2) years’ experience in Care Coordination, home health, discharge planning and/or ambulatory experience.
• Nationally certified through ANCC approved certifier (preferred).
• Bilingual English/Spanish verbal and written fluency (preferred).