Patient Care Coordinator

Essential Responsibilities

• Utilization Management: Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.
• Monitors the progression of the discharge plan and facilitates discussions with the multidisciplinary teams.
• Educates other healthcare team members on utilization and care coordination.
• Collaborates with and provides information to patients, families, physicians, and staff regarding the discharge plans and transitions.
• Understands and consistently applies the interpretation and utilization of member health care benefits.
• Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements.
• Discharge Planning: Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning, and obtaining authorizations/approvals as needed for outside services for the patient.
• Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other health care providers and agencies.

Experience

Basic Qualifications:

• Minimum four (4) years of experience in hospital patient care delivery, OR completion of a Master’s degree in a case management program in lieu of minimum years of experience.

Education

• Graduate of an accredited school of nursing.
• Diploma/Associate Degree in Nursing.

License, Certification, Registration

• Registered Nurse License (California)
• Basic Life Support

Additional Requirements

• Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPAA, ERISA, EMTALA & all other applicable federal/state/local laws & regulations.
• Demonstrated strong communication and customer service skills, problem-solving, critical thinking, & clinical judgment abilities.
• Fundamental word processing & computer navigation skills & the ability to interpret & use analytic data in day-to-day operations.
• Knowledge of health care benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).
• Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications

• Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred.
• Bachelor’s degree in nursing or a health care related field preferred.
• Master’s degree in case management preferred.