POSITION DESCRIPTION
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POSITION SUMMARY: The Clinical Care Coordinator
comprehensively plans for Care Management of targeted patient populations.
Performs resource management, including denial management, utilization
management, access to the appropriate level of care, discharge planning, care
facilitation, and referral to other levels of care. Works collaboratively
with the multidisciplinary care team to facilitate achievement of desired
treatment outcomes |
MINIMUM
QUALIFICATIONS: |
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EDUCATION,
CERTIFICATION, AND/OR LICENSURE: |
|
1. |
Current West
Virginia licensure as a Registered Professional Nurse or licensure as
Registered Professional Nurse in another state with a temporary West Virginia
practice permit. |
EXPERIENCE: |
|
1. |
Five (5) years
clinical experience. |
PREFERRED
QUALIFICATIONS: |
|
EDUCATION,
CERTIFICATION, AND/OR LICENSURE: |
|
1. |
Bachelor’s Degree in Nursing. |
EXPERIENCE: |
|
1. |
Prior Care Management experience. |
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to
describe the general nature of work being performed by people assigned to
this position. They are not intended
to be constructed as an all-inclusive list of all responsibilities and
duties. Other duties may be assigned. |
|
1. |
Manages all
aspects of transition/discharge planning for assigned patients in a timely
manner. |
2. |
Collaborates
with all members of the multidisciplinary team to facilitate the
transition/discharge process for designated caseload. |
3. |
Monitors the
patient’s progress; intervening as necessary and appropriate, to ensure that
the plan of care and services provided are patient focused, high quality,
efficient, and cost effective. |
4. |
Provides
education as needed to staff, physicians, and patients and their families to
ensure effective transition planning. |
5. |
Meets directly
with the patient and/or family to assess needs and develop an individualized
transition/discharge plan in collaboration with the physician team. |
6. |
Communicates
with the multidisciplinary team and post-acute providers when applicable, any
complex family dynamics that may directly impact patient care and
transition/discharge planning. |
7. |
Initiates
and facilitates referrals to post-acute services- including but not limited
to: Homecare, Durable Medical Equipment, Hospice Care, Long Term Acute Care
Facilities, Acute Rehab Facilities, and Skilled Nursing Facilities. |
8. |
Communicates
all necessary information regarding transition/discharge plan to the
multidisciplinary team, patient and family. |
9. |
Provides
timely and comprehensive documentation of interactions with patient and/or
families and all transition/discharge planning activities and progress
according to departmental policy. |
10. |
Working
knowledge of patient’s current medical insurance coverage and limitations and
the precertification requirements for Durable Medical Equipment (DME),
post-acute placements, infusions, transfers etc. |
11. |
Assists
patient/families with completion of medical power of attorney, health care
surrogate, and advanced directives |
12. |
Collaborate
for appropriate resource and financial management which may include but is
not limited to: financial assistance coordination/referrals, entitlement
program coordination/referrals, or patient benefit coordination |
13. |
Uses
quality screens in the electronic record to identify potential issues
including but not limited to- avoidable delays and readmissions. |
14. |
Responsible
for completion of all clinical reviews for patients admitted and discharged
to WVU Medicine, including patients admitted and discharged over the weekend. |
15. |
Applies approved utilization
criteria to ensure medical necessity of patient’s admissions and continued
stays, and documents the findings based on department standards, policy and
procedure. |
16. |
Screening for
appropriate authorization and level of care for admission to WVU Medicine
Same Day Surgery and IP Surgery suite. |
17. |
Communicates
with Resource Center and /or third party payors to facilitate covered day
reimbursement certification for assigned patients and discusses payor
criteria and issues on a case by case basis with clinical staff (ie. Peer to
Peer) and follows up to resolve problems with payors as needed. |
18. |
Educates
hospital staff and physicians to payer regulations and managed care
principals to prevent denials. |
19. |
Fosters the
integration of staff and/or students into the healthcare team. |
20. |
Exhibits
professional behavior on a consistent basis. |
PHYSICAL REQUIREMENTS: The physical demands described here are
representative of those that must be met by an employee to successfully
perform the essential functions of this job. Reasonable accommodations may be
made to enable individuals with disabilities to perform the essential
functions. |
|
1. |
Prolonged walking,
standing, or sitting. |
WORKING ENVIRONMENT: The work environment characteristics described here
are representative of those an employee encounters while performing the
essential functions of this job. Reasonable accommodations may be made to
enable individuals with disabilities to perform the essential functions. |
|
1. |
Required on
call and weekend/holiday rotations as needed. |
SKILLS AND ABILITIES: |
|
1. |
Possesses
excellent interpersonal communication and negotiation skills in interactions
with patients, families, physicians, and health care team colleagues. |
2. |
Ability to work
with people of all social, economic, and cultural backgrounds and be
flexible, open minded, and adaptable to change. |
3. |
Capable
of independent judgment and action regarding psychosocial needs of patients. |
Date Reviewed/Revised: May 2021 |