MH RN Care Coordinator

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Summary

The RN Care Coordinator is responsible for overseeing the appropriate level of care and collaborates with the Social Work partner regarding discharge planning with a particular focus on medically complex discharge planning.

Summary

The RN Care Coordinator is responsible for overseeing the appropriate level of care and collaborates with the Social Work partner regarding discharge planning with a particular focus on medically complex discharge planning.

The RN Care Coordinator will be assigned to selected areas of the Hospital based upon department staffing and coverage.

The RN CC will collaborate with the SW Care Coordinator as a team to meet the needs of the patients within unit assigned.

As this is an evolving position duties and responsibilities may vary based on specific assignments.

Each staff member will participate in a departmental orientation focused on Case Management Standards of Practice.

All staff will be cross-trained and oriented with the ED Case Management Practice.

Responsibilities



KEY RESPONSIBILITIES:

UM Reviews and Denial Support

• Perform Inter Qual Admission Assessments on all new admissions and forward the reviews to insurers as needed. Answer questions from the insurers and continue to provide any additional clinical information they request. Timely reviews to be provide so payers have sufficient time to review case and respond quickly.
• Communicate in real time with physicians on any patients not meeting criteria and establish a course of action.
• Work collaboratively with the MDs to help them understand documentation issues or any leveling issues or any leveling issues. Inform physician partners on Inpatient vs. Observation criteria or acute care criteria.
• Provide education to them regarding Inpatient vs. Observation criteria or daily care criteria.
• Act as liaison to managed care case managers for evaluating medical management of patients referring questions to Medical Directors and/or payers when appropriate.
• Perform concurrent/daily Inter Qual reviews on assigned patients and document when Inter Qual criteria is not met.
• Forward all reviews to insurers on a timely basis.
• Answer any questions from insurers.
• Perform concurrent denial management to resolve issues prior to discharge of patient. Inform Directors/designee regarding outcome.
• Upon receipt of admitting or daily denials from insurers review the case and provide the insurer with additional clinical information for the insurers' reconsideration.
• Complete the clinical record and profile on a patient profile in Allscripts or a Steward designated software tool. Utilize the Allscripts tool appropriately so all fields are complete all clinical information is fully recorded all changes to a patient's clinical condition is recorded all interaction with insurers RNs MDs is documented as appropriate.
• Copy the Allscripts clinical information and place in medial record as appropriate.
• Finalize authorization for stay for all covered days prior to case closure
• The RN Care Coordinator provides resource 365 days per year.
• Rotate to other units of the Hospital including the ED as directed by the Care Coordinator Manager and the schedule for the Department.
• Rotation of holidays will be assigned as agreed under th Care Coordinator Model settlement.
• Rotation of weekends will be assigned based on each hospitals collective bargaining agreement and practice.

• Review initial Admission Assessments and proposed discharge plans outlined by the SW Care Coordinator. Collaborate with SW Care Coordinator on discharge plan.
• Identify the patients/discharges that may be complicated and review these discharges with the Social Worker.
• Coordinate and monitor discharge planning activities for an assigned patient population and provide support to the Social Workers and administrative staff managing the discharge process.
• Collaborate with the Interdisciplinary team to crate an individualized discharge plan for high risk patients as needed ensuring appropriate level of services are scheduled for the patient.
• Inform PCP's attending physicians and clinical staffs on alternative discharge options including high-tech home care skilled nursing facility capabilities and disease management initiatives in collaboration with SW Care Coordinators.
• Communicate pertinent patient information on an as needed basis with skilled nursing facilities community health Agencies physicians and other staff to insure all post-acute clinical information is provided.
• Information to be provided on a timely basis to not delay discharge.
• Obtain information from the CC Manager and CC Supervisor on Social Workers assignment and provide feedback as needed on SW assignments priority of work and any follow-up issues.
• Be aware of disease…