Clinical Support Coordinator (197)
Hancock Regional Hospital
Greenfield, IN
Full-time
Health Care Provider
Posted on June 5, 2020
Category Quality - 7181 Description
JOB SUMMARY:
- To perform concurrent utilization review using appropriate criteria in acute/sub-acute settings for assigned patient populations.
- Daily, the CSC reviews the patient for appropriate level of care, resource utilization and length of stay.
- Monitors all observation patients and facilitates discussions between physicians and the care team to meet the expectations for care.
- Assists with compliance with CMS core measures through concurrent review of the medical record and notification of providers of identified issues in the absence of the Clinical Performance Analysis.
- Utilizing Process Improvement methodology, clinical expertise and proven leadership skills, this individual participates in process improvement activities in the assessment, planning, and implementation of quality/performance initiatives.
- This position provides for continual feedback, education, monitoring, and evaluation of quality measures across the continuum of care to ensure optimal patient outcomes and appropriate utilization of healthcare services.
- Assumes the role of the Case Manager/Discharge Planner when assigned (see these role responsibilities in the Job Stat's).
- Participate in an on-call rotation to ensure patient and customer needs are met in a timely fashion.
- Performs other duties as assigned.
QUALIFICATIONS:
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
- Works in an independent and interdependent relationship with members of the medical staff, which allows for consultation, collaboration, or referral.
- Reviews all incoming admissions including direct, emergency department, OPU and surgical admits.
- Reviews include but are not limited to identifying Intensity of Services and Severity of Illness in order to place patients in correct admission status.
- Appropriately screens and refers patients to EHR for compliance reviews.
- Works collaboratively with the Case Management and UM Coordinator to conduct utilization review/ management of acute, chronic, and long-term healthcare issues.
- Work collaboratively with the UM Coordinator to conduct UR validation reviews to include preauthorization, insurance continued length of stay reviews and prior authorizations.
- Works collaboratively with the healthcare team to coordinate early discharge planning to appropriate level of care.
- Facilitate CMS and/or notice of non-coverage reviews and correspondence.
- Conduct CMS Core Measure concurrent reviews for all patients and communicate the outcome with Clinical Performance Analyst regarding CMS core measure reviews.
- Collaborates with members of the multidisciplinary team in assessing, planning, implementing and evaluating health care delivery and monitors progress of patients, reports to supervising physician when patient’s progress does not meet anticipated/predetermined criteria.
- Collects data needed to evaluate discharge delays, care delivery delays, and readmissions.
EXPECTED BEHAVIORS:
- Uses critical thinking skills necessary to make independent, ethical decisions.
- Possesses effective written and verbal communication skills.
- Able to meet deadlines, work independently and is self-directed.
- Possesses highly developed organizational skills with attention to detail.
- Is a strong, supportive interdisciplinary team player.
- Supports learning needs of physicians and staff.
- Demonstrates self-directed learning and participates in the continuing education to meet own professional development.
- Demonstrates skills as a resource and consultant to the unit staff, care team members and physicians.
- Maintains data and patient information in a confidential manner
- Demonstrates flexibility in work situations
- Maintains professional, ethical and accountable behaviors consistent with Patient’s First in the delivery of patient care, staff and physician interactions.
- Supports and promotes the mission and vision of Hancock Regional Hospital.
CERTIFICATION/LICENSE: Registered Nurse (RN)
ADDITIONAL EDUCATION AND EXPERIENCE REQUIREMENTS:
- RN with a minimum 5 years’ clinical experience.
- Graduate of accredited nursing program.
- BSN preferred
- Previous experience in Process Improvement. Mandatory Annual Continuing Education: Customer Service, Fire and Safety, Confidentiality-HIPAA, Infection Control, Corporate Compliance.
- Annual Unit Specific Competencies, and all education required by regulatory, accreditation bodies and/or Hancock Regional Hospital.
Today, a highly skilled medical and professional nursing staff anchors Hancock Regional Hospital. We have a state-of-the-art surgery department, 24-hour emergency services, OB services, progressive and critical care, a geropsychology unit, home healthcare, occupational health, a transitional care unit, a total oncology program with a cutting-edge radiation oncology center, many private rooms, and a full complement of Inpatient and outpatient services.
Our Mission is to be a Caring Community Partner by healing, improving health and wellness, alleviating suffering, and delivering acts of kindness one person at a time. EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.
This position is currently accepting applications.
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