Lead Care Coordinator / UM Shore @ Easton

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Job ID: 60557
Area of Interest: Nursing
Location: Easton, MD US
Hours of Work: 8-4
Job Facility: UM Shore Regional Health
Employment Type: Full Time
Shift: DAY
What You Will Do:

JOB SUMMARY:

Provides on-site operational supervision to Care Coordinators to assure quality and efficient service.

The Care Coordinator Lead is responsible for the achievement of optimal health for the patient, access to care and appropriate utilization of resources, balanced with the patient’s right to self-determination The Care Coordinator Lead, with respect to payer requirements, will ensure timely notification and communication of pertinent clinical data to support admission, clinical condition, continued stay and authorization of post-acute services.

 

 

ESSENTIAL FUNCTIONS OF THE JOB:

 

Supervision:

  1. Assumes responsibility for the daily operations of Care Coordination Staff.
    1. Coordinates staff in daily activities, work assignments and scheduling. 
    2. Provides input into staff Performance Appraisals.
  2. Works with Care Coordination Director to establish department goals and develop performance improvement activities.
  3. Collaborates with other Care Coordination Lead positions implementing and maintaining on-going cross-training programs.   
  4. Assists with the selection and orientation of new employees.
  5. Maintains current knowledge of reimbursement models; ensures department procedures support same.
  6. Identifies need for continuing education and training to keep staff knowledgeable in current practice.
  1. Works with Director and other team leaders to coordinate approval of time off requests to ensure adequate coverage.

 

Clinical:

1. The Care Coordinator Lead will assess patients for clinical, psychosocial, financial and operational factors that may affect the progression of care. Using these criteria stratify patients at risk for over utilization of services and/or in need of care coordination services.

2. Collaborate with clinical team to reduce inpatient length of stay and reduce readmissions across the organization

3. Performs and documents appropriate admission and continued stay reviews using current InterQual/Milliman Care Guidelines criteria on assigned patients.

4. Based on the health care team's assessment, patient choice and available resources, develops an effective transition plan.

5. Actively participates in CTR rounds; interprets, and integrates the patient’s story into the overall multidisciplinary plan of care.

6. Develops and implements corrective action plans for resolution of complex problematic issues and elevates to management as necessary.

7. Documents appropriately per care coordination policy. Responsible for documenting information that is not duplicative but instead is complementary and contributes to the progression of the plan of care.

8. Collaborates with Physician Advisor for complex issues related to the medical plan of care.

9. Actively participates in clinical performance improvement activities as assigned.

10. Remains current on clinical practice and protocols impacting clinical reimbursement.

Utilization Management Lead Duties:

  1. Maintains current knowledge of CMS and other regulatory requirements related to utilization management
  2. Serve as a resource to other healthcare professionals in field of Utilization Management

Inpatient Lead Duties:

  1. Facilitates patient flow during hospital stay, promoting an interdisciplinary care team process.
  2. Work with director to establish goals related to LOS, Avoidable Days, Observation and other topics.

 

 



What You Need to Be Successful:

  • Graduate of an approved registered nursing program with current RN license in the State of Maryland.
  • Three years of experience in an acute care hospital.
  • 2 years’ of experience in case management and/or utilization management required.
  • Demonstrated excellent verbal and written communication, interpersonal and organizational skills required.

We are an Equal Opportunity/Affirmative Action employer.  All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. 
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