Care Coordinator- Care Management

Overview

Establishes and maintains an efficient, cost effective care management process by determining patient financial and medical eligibility, medical necessity, and by developing, implementing and monitoring individual patient plans of care and communicating these plans to patients, families, and Parkland staff to ensure quality patient care throughout the healthcare continuum and compliance with program/Parkland policies and procedures. Responsible for maintaining the knowledge and skill set related to utilization review, care coordination, performance improvement and professional licensure and certification.

Location:

Main Hospital Building, 1st Floor

Shift: Days | Work Hours (Monday-Friday)
• Onsite only

Employment Type:

Full Time

Education

• Must be a graduate of an accredited school of Nursing.

Experience

• Must have two (2) years of hospital or community-based patient care nursing, preferably in assigned clinical area.

• Must have current, valid RN license or temporary RN license from the Texas Board of Nursing; or, valid Compact RN license.
• Must have current healthcare provider BLS for Healthcare Providers certification from one of the listed Cost Centers (48000 - COPC Admin, 71720 Infectious Disease/OPAT, 74050 - Gynecology Dysplasia, 75000
  - Employee Health Center, 83600 - Transitional Care Unit, 85100 - Corr Hlth Adult Clinical):
  American Heart Association, American Red Cross, Military Training Network.

• Provides care to assigned patient population in accordance with the current State of Texas Nursing Practice Act, established protocols, multidisciplinary plan of care, and clinical area specific standards.
• Communicates and collaborates effectively with a diverse group of patients, families and healthcare staff.
• Demonstrates working knowledge of specific patient populations and disease processes affecting this group.
• Demonstrates working knowledge of PC operations and ability to use word processing software in a Windows environment.
• Demonstrates working knowledge of laws and regulations governing Medicare, Medicaid and community-based funding sources.
• Self-directed with ability to prioritize and solve problems.
• Demonstrates patient-centered/patient-valued behaviors.

• Conducts patient assessment on the assigned Care Coordination team to develop a case management plan of care; gathers information from patient, physicians, and other healthcare team members; determines funding sources and potential eligibility; plans objectives and actions to meet patient needs; uses hospital review criteria to ensure appropriate bed status; identifies at-risk populations and follows reporting procedures; ensures appropriate admission status is documented.
• Collaborates with the multidisciplinary team and patient to implement the plan of care; monitors progress, intervenes as needed to ensure care is patient-focused, high quality, efficient and cost effective; communicates financial counseling as appropriate; resolves barriers impeding progress; facilitates timely discharge; maintains plan consensus among patient/family, physician, and payer; advocates for coverage of needed community services; mobilizes resources to facilitate transitions to the appropriate next level of care.
• Communicates plan of care to patient/family, provides updates, and reassesses the plan to determine effectiveness; completes appropriate coordinator management documentation; evaluates plan effectiveness at intervals; coordinates discharge needs and teaching with nursing and other disciplines.
• Collaborates with the healthcare team to identify best practices for outcomes and develops reporting mechanisms to communicate outcomes to physicians and team members.
• Responsible for Utilization Management activities for assigned patients; applies approved utilization criteria to monitor admissions and continued stays, documents findings; monitors length of stay and resource use, and pursues continuous improvement.
• Monitors outcome variances, identifies causes, and implements actions to improve.
• Supports cost containment through performance improvement opportunities; communicates with Care Management to facilitate reimbursement certification/authorization; discusses payer criteria with clinical staff and resolves payer issues as needed.
• Transitions patients through the health care system based on individual and population needs; coordinates services, health promotion, disease prevention, health education, screening, and community resource linkage.
• Engages in special projects and serves on assigned committees.

Requisition : 985140