Hospital Coordinator & Case Manager, Readmissions Reduction Program

Overview

The Readmissions Reduction Hospital Coordinator is responsible for the oversight, coordination, and administration of the Readmissions Reduction Program on-site at the hospital(s). This is an implementation-focused role, with an emphasis on relationship building with hospital staff and adapting the Readmissions Reduction Program to fit in this particular hospital setting. Specifically, this work includes coordinating with hospital staff, participating in hospital rounds, and intaking potential participants.

Additionally, managing the administrative/operational flow of participants into the program. Further, serves as case manager for clients with mental illness and/or substance use disorders as program needs require. The section on Essential Functions is split into (1) Program Coordination-specific functions and (2) Case Manager-specific functions.

Location

This is a hybrid position, where 25% of work is from home and 75% is on-site at several hospitals in both Falls Church and Alexandria, Virginia.

This is a dual role encompassing Hospital Coordinator and Case Manager duties as outlined below:

• Coordinate with leadership to ensure that all hospital documentation has been received
• Participate in clinical meetings with medical team at the hospital and provide daily, accurate written documentation regarding clients to case managers
• Assure all necessary patient and hospital data is gathered and recorded
• Collaborate with case managers to provide information and ensure that all necessary patient information has been provided/obtained
• Collaborate with leadership to assist with assignment of patients to case managers as needed
• Manage and enter timely necessary data and details into hospital specific tracking mechanism
• Ensure that all intakes are completed in a timely manner prior to discharge
• Participate and coordinate with emergency department and crisis intervention service staff to partner proactively to deter unnecessary admissions
• Work with leadership at the hospital to implement program
• Facilitate and maintain a positive working relationship with all hospital staff
• Act as a liaison between hospital medical and social work staff and Mindoula to ensure care coordination services are provided in a supportive and streamlined manner
• Promote and provide education about Mindoula’s case management services
• Advise leadership as necessary to ensure that care coordination is carried out to best practices

• Highly resourceful team-player, with the ability to be extremely effective when working independently.
• Proven ability to handle confidential information with discretion, be adaptable to various competing demands, and demonstrate the highest level of customer/client service and response.
• Demonstrate ability to achieve high performance goals and meet deadlines in a fast paced environment.
• Demonstrate proactive approaches to problem-solving with strong decision-making capability
• Counsel clients with a mental and/or physical disability to assist them with the goal of overcoming dependencies, adjusting to life, and making changes
• Guide clients in the development of skills and/or strategies for managing problems and triggers to increase relapse prevention and reduce risk
• Educate clients about mental or physical illness, abuse, medication, and available community and social resources
• Assess clients for risk, make quick evaluations for risk, and respond, formulating and performing crisis intervention that ensures the safety of clients as necessary
• Formulate interventions with internal and external programs that impact clients and their ability to maintain in the community, being sensitive to clients’ cultural, educational and religious needs
• Identify triggers and environmental impediments to clients’ progress through interviews and review of records, making reasonable accommodations as necessary
• Prepare and maintain all required records, reports, paperwork, and clients’ diagnostic records, maintaining confidentiality of clients at all times
• Use clear and accurate communication skills (both verbal and written) to facilitate communication with the clients, clients’ family/caregivers,…