Care Transition Coordinator, Care Management II - 26-67

PriMed Management Consulting•Stockton, CA

45d•Onsite

About The Position

The CTC provides administrative support by facilitating pre and post-acute care needs to avoid readmissions and ER visits. Serves as a liaison between hospital clinicians, providers, vendors, nursing facilities and HPMG Care Management staff. Handles nonclinical activities within the scope of either Inpatient, Welcome Home, or Case Management functions per skills and experience level. Duties such as: processing authorizations for discharge needs, scheduling PCP and specialist appointments, coordination of care at the bedside and PCP offices, and referring patients to appropriate Case Management staff. Monitors and tracks issues received to assure timely resolution and feedback communication to the referral source.

Requirements

3-5 years of related managed care experience required
Working knowledge of medical terminology
Ability to coordinate effectively with a variety of customers including members, providers, hospital and office staff, health plans, internal departments, community resources, and peers
Ability to work independently as well as in a team environment
Multi-tasking, ability to prioritize, and strong critical thinking skills
Excellent organizational and communication skills and ability to meet timeframes
Computer Experience: proficiency with routine applications including Microsoft Word and Excel, EHR and or web-based application

Nice To Haves

Experience with CPT/ICD9/ICD10 codes preferred

Responsibilities

Completes intake process – facesheet receipt, verifies eligibility and builds referral into authorization, attaches clinical records and routes authorization to appropriate clinical queue within TAT requirements.
Verifies benefit details with the health plans.
Calculates LACE score at time of admission and documents in the authorization.
Assists nursing staff in obtaining clinical information from facilities and summarizes information for continuing nursing facility stays, processes letters as directed by the CCR/TOC nurses, and processes authorizations which require only administrative level of review.
Serves as contact to receive and process authorizations needed to support timely discharge from hospital or nursing facilities and subsequently routes cases to the appropriate care team.
Engages patient and caregivers upon admission to the hospital and throughout the hospital stay, discharge instructions, transition preparedness, follow-up appointments within 7 days of discharge, and care to assure the patient understands the treatment plan and is well prepared for transition to the next level of care, in coordination with the TOC/CCR nurse.
Shares the treatment/discharge plan created by the TOC nurse with member and appropriately communicates information so the patient is well prepared for transition to the next level of care.
Participates in physician/case management/concurrent review rounds as needed.
Completes ad hoc health plan drilldown requests.
Travels to hospitals in assigned regions in Sacramento, San Joaquin or the Bay Area, up to 100% of the time.
Maintains client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.
Performs other duties as assigned.
Receives in-basket notification of discharge and/or identifies discharge from hospital EMR, calculates discharge LACE score and routes case to appropriate team member following episode creation.
Uploads discharge summaries, medication list and other documentation to the Welcome Home episode in Epic.
Completes initial Welcome Home call to member within 36 hours for appropriate LACE score and refers high risk cases to Welcome Home nurse.
Follows up and addresses any needs identified during outreach call.
Sends letters externally as appropriate.
Collaborates with interdisciplinary team via telephonic outreaches to support implementation of the identified discharge plan.
Makes PCP follow-up appointment as soon as possible after discharge with primary care doctor (and with specialists as needed) for a visit for not more than 7 days after discharge.
Travels to PCP offices in assigned regions in Sacramento, San Joaquin or the Bay Area, at minimum once per quarter or as needed.
Creates episode for referral to Case Management.
Runs LOH report, creates episode, makes initial outreach and refers case to health plan, Case Manager or Social Worker as deemed appropriate.
Outreaches to members for non-complex needs and updates chart notes.
Offers education to member about Case Management services and available resources in coordination with Case Managers.
Refers appropriate cases to designated staff as identified in workflows.
Enters transition notes upon referral to designated staff.
Makes PCP follow-up appointment as soon as possible after admission with primary care doctor (and with specialists as needed) for a visit for not more than 7 days after discharge, if applicable.