Schedule: Regular Full-time
Guiding patients through the healthcare system by assisting with access to healthcare
Developing relationships with participating physicians and service providers
Managing resources through interdisciplinary collaboration to achieve optimal patient outcomes
Coordinating the logistics for plan adherence – appointment reminders, transportation, and childcare arrangements
Ensuring that medication adherence issues are addressed.
Roles & Responsibilities:
Proactively facilitates referral, transition, ordering of equipment (e.g. DME), and placement. Coordinates with key stakeholders and expedites final transfer with staff, patient, family and facility.
Maintains contact with appropriate facilities to advocate patient admissions
Participates in family and interdisciplinary team meetings as appropriate to develop and execute the discharge plan
Assesses referred patients to determine if appropriate for homecare or placement; determines if agency care effectively meets needs of the referred patient
Maintains a directory on referrals, admissions and homecare / community agency resources and tracks discharge process utilized by the patient. Maintains current information on non-acute provider agencies, including SNF, sub-acute, acute rehab and chronic facilities, including programs, homecare and specialties available. Acts as a resource to staff, patients and families concerning this information.
Updates the staff on new facilities and services and maintains a library of reference materials
Interprets insurance coverage for homecare of referred patients and obtains approval for services by payer or negotiates method of payment before discharge
May attend LOS meetings and follow ups on key tasks to ensure efficient facilitation of patient care as delegated
Administers programs, projects, and/or processes specific to operating unit served
May serve as administrative liaison for others within and outside the Health System enterprise regarding administrative and placement issues
May establish work priorities and scheduling; may train other resource specialists or administrative support staff
Drafts, edits, proofreads and prepares correspondence; creating reports, graphs, and presentations as needed
Researches files and documents. Collects data for maintenance of required records. Aggregates collected data to generate routine reports and statistics for the Care Management department.
Experience & Education Requirements:
- High school diploma or equivalent required. Associate's or higher degree preferred.
- At least two (2) years' experience in hospital discharge planning, long term care, community health or utilization review required. Experience in extended care facilities and community agencies preferred
Bilingual (English/Spanish) preferred
Strong knowledge of healthcare resources, benefits and entitlements in the local area
Strong communication and interpersonal skills, including ability to work collaboratively and cooperatively within a team and internal and external customers
Ability to work in a fast-paced environment
Strong organizational skills and ability to set priorities
Ability to develop and maintain positive relationships with internal and external customers
Equal Opportunity Employment