Care Transition Coordinator II, Care Management - 26-124

PriMed Management Consulting • Stockton, CA

5d

About The Position

The Care Transition Coordinator II provides advanced administrative support to facilitate pre- and post-acute care needs and help prevent readmissions and emergency room visits. The coordinator serves as a liaison among hospital clinicians, providers, vendors, nursing facilities, and Hill Physicians Medical Group Care Management staff. The role handles nonclinical activities across Inpatient, Welcome Home, and Case Management functions, with a primary focus in one area and practice in the other two at least quarterly or as requested. Duties include processing authorizations for discharge needs, scheduling primary care and specialist appointments, coordinating care at bedside and in provider offices, referring patients to appropriate Case Management staff, and tracking issues through resolution while communicating feedback to referral sources.

In the Inpatient function, the coordinator processes referrals and authorizations, verifies eligibility and benefits, calculates and documents LACE scores, supports clinical information gathering, facilitates timely discharge, communicates transition plans with patients and caregivers, and participates in rounds as needed. In Welcome Home, the coordinator processes discharge notifications and documents, contacts members, addresses identified needs, coordinates follow-up care, and schedules post-discharge appointments. In Case Management, the coordinator creates referral episodes, conducts initial outreach, refers cases to appropriate staff or resources, provides information about Case Management services, and documents transitions. The position requires travel to hospitals or primary care offices in assigned regions of Sacramento, San Joaquin, or the Bay Area, as specified for the applicable function. The coordinator safeguards client privacy, safety, confidentiality, and advocacy in accordance with ethical, legal, regulatory, and accreditation standards.

Requirements

• 3–5 years of related managed care experience.
• Working knowledge of medical terminology.
• Ability to coordinate effectively with members, providers, hospital and office staff, health plans, internal departments, community resources, and peers.
• Ability to work independently and in a team environment.
• Multitasking, prioritization, and strong critical-thinking skills.
• Excellent organizational and communication skills, with the ability to meet timeframes.
• Proficiency with routine computer applications, including Microsoft Word and Excel, and experience with an EHR and/or web-based applications.
• High school diploma or GED.

Nice To Haves

• Experience with CPT, ICD-9, or ICD-10 codes.

Responsibilities

• Process inpatient intake, including receiving facesheets, verifying eligibility, creating authorization referrals, attaching clinical records, and routing authorizations within required turnaround times.
• Verify health plan benefit details and calculate and document LACE scores at admission or discharge as applicable.
• Assist nursing staff in obtaining clinical information from facilities, summarize information for continuing nursing facility stays, process letters as directed by CCR/TOC nurses, and process authorizations requiring administrative review.
• Receive and process authorizations needed for timely discharge from hospitals or nursing facilities and route cases to the appropriate care team.
• Engage patients and caregivers during hospitalization and support understanding of discharge instructions, transition preparedness, follow-up appointments, and treatment plans in coordination with TOC/CCR nurses.
• Participate in physician, case management, and concurrent review rounds as needed, and complete ad hoc health plan drilldown requests.
• Receive or identify discharge notifications, create Welcome Home episodes, calculate LACE scores, route cases, and upload discharge summaries, medication lists, and other documentation to Epic.
• Complete initial Welcome Home calls within 36 hours for appropriate LACE scores, refer high-risk cases to a Welcome Home nurse, follow up on needs, and send external letters as appropriate.
• Coordinate with interdisciplinary teams through telephone outreach to support discharge plans and arrange primary care and specialist follow-up appointments, generally within seven days after discharge.
• Create Case Management referral episodes, run LOH reports, conduct initial outreach, and refer cases to health plans, Case Managers, Social Workers, or other designated staff as appropriate.
• Conduct outreach for non-complex member needs, update chart notes, explain Case Management services and resources, and enter transition notes upon referral.
• Travel to hospitals in assigned Sacramento, San Joaquin, or Bay Area regions up to 100% of the time for the Inpatient function; travel to PCP offices in assigned regions at least once per quarter or as needed for Welcome Home and Case Management functions.
• Maintain client privacy, safety, confidentiality, and advocacy in accordance with ethical, legal, regulatory, and accreditation standards.
• Perform other duties as assigned.

Benefits

• The employer notes that it has been recognized as one of the Best Places to Work in the Bay Area and one of the Healthiest Places to Work in the Bay Area.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED