Transitions of Care Coordinator- 55+ adult population -Remote

Fallon Health • Worcester, MA

270d

About The Position

The Transitions of Care Coordinator uses a multidisciplinary approach to ensure that SE participant transitions of care to and from inpatient facilities are appropriate, timely, and successful. In collaboration with the SE IDT, the coordinator ascertains that participants are in receipt of high quality cost-efficient care and outcomes.

Requirements

• Associate of Science in Nursing, Bachelor of Science in Nursing (preferred)
• Licensed by the Commonwealth of Massachusetts Board of Registration in Nursing as a Registered Nurse
• Valid Driver's License
• CCM or similar certification desired
• Three to five years nursing experience with one year experience working with a frail or elder population
• Recent case management or utilization management experience and knowledge of criteria for medical necessity determination preferred
• Must possess strong interpersonal, analytical and communication skills

Responsibilities

• Attends daily IDT meetings to discuss inpatients and suggest discharge plans
• Utilize a checklist to ensure that the components of a safe transition of care occur
• Communicates daily with primary team members to address potential barriers to discharge or transition to lesser care setting
• Participates in family meetings as needed
• Participates in contracted facility case management meetings to address potential barriers/facilitate successful discharge planning
• Collaborate with facilities, IDT members and others involved in participants plan of care to ensure safe, efficient transitions from facility to facility and to the home setting
• Facilitate pertinent record exchange to and from facilities for continuity of care and medication reconciliation
• Acts as a liaison between facilities and IDT members to convey progress
• Access resources out of network to meet participant needs
• Utilize Collective Medical to track transitions in real time
• Supports the fundamental mission of the Summit ElderCare program
• Determines tier of service at subacute facilities
• Conduct concurrent and retrospective utilization review for inpatient, observation or SNF services
• Recognizes, identifies, and implements appropriate opportunities to help meet Utilization goals
• Knowledge of managed care, quality, and risk management principles
• Participates in the SE Utilization Committee
• Generate Ad Hoc request when required
• Concurrent and retrospective review utilizing a multitude of systems and electronic records
• Enters authorizations in applicable systems to ensure that claims are adjudicated efficiently
• Documents all inpatient care transitions and case management progress notes within the electronic health record
• Generate Transitions of Care Templates to accurately reflect transitions and level of care
• Track Vendor Denials
• Identify quality/risk factors in continuum of care and report to Medical Director and Quality Team
• Utilize clinical judgement and critical thinking to suggest alternative measures for provision of care

What This Job Offers

• Industry: Hospitals
• Education Level: Associate degree