Continuing Care Coordinator

GBMC HealthCare•Towson, MD

3d•$20 - $30•Onsite

About The Position

Under limited supervision, the Continuing Care Coordinator assists the Care Management (CM) team with administrative functions and coordinates with team members and other hospital disciplines to support smooth care transitions. The role helps maintain hospital compliance with required documentation, including IMM, MOON, and OBS letters. It also involves obtaining prescription and Skilled Nursing authorizations, arranging primary care appointments, and conducting follow-up discharge calls to recently discharged patients. The coordinator documents completed work in EPIC, including notes, work queues, the Media section, forms, PCP appointments, the After Visit Summary (AVS), and discharge summaries. The position is performed in organizational offices, patient care units, and patient rooms, and requires regular attendance in all types of weather. The employee is expected to understand patient and workforce safety relevant to the role and demonstrate competency in meeting applicable age-specific patient needs.

Requirements

Bachelor’s degree or equivalent experience preferred.
Three years of experience in a health care setting preferred.
Three years of customer service experience preferred.
Knowledge of available community resources.
Advanced oral and written communication skills.
Ability to organize workload and balance multiple tasks.
Time-management skills.
Skills in data and statistical analysis.
Ability to evaluate gathered data for a medical plan of treatment.
Ability to concentrate and pay close attention to detail.
Ability to walk throughout the hospital, including between patient rooms and other organizational units.
Ability to work from work queues.

Nice To Haves

Bachelor’s degree or equivalent experience.
Three years of experience in a health care setting.
Three years of customer service experience.

Responsibilities

Ensure IMM, OBS, and MOON letters are provided to patients in a timely manner to meet regulations.
Ensure delivery of the Secondary IMM letter.
Deliver and discuss the Medicare Important Message (IMM), Acknowledgement of Outpatient Services, and MOON letters.
Schedule appointments with primary care physicians for patients at high risk of readmission.
Assist the Care Management team with administrative tasks, including discharge paperwork, faxing, referrals, follow-up calls, PCP appointments, and authorizations.
Obtain prescription and Skilled Nursing authorizations, including contacting pharmacies and insurance companies.
Conduct follow-up discharge calls to recently discharged patients.
Document completed work in EPIC notes, work queues, the Media section, and records related to forms, PCP appointments, AVS, and discharge summaries.
Coordinate with the Care Management team and other hospital disciplines to support care transitions.
Speak with patients and families to deliver letters and answer questions.