Description
At ScionHealth , we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.
Job Summary
Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.
Essential Functions
Care Coordination
Assist in coordinating clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians
Assists with effective care coordination and efficient care facilitation
Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care
Appropriately refers high risk patients who would benefit from additional support
Serves as a patient advocate
Knowledgeable of the principles of growth and development over the life span and the skills necessary to provide age-appropriate care to the patient population served
Participates in interdisciplinary patient care rounds and/or conferences
Collaborates with clinical staff in the execution of the plan of care, and achievement of goals
Discharge Planning
Under appropriate supervision, conducts comprehensive, ongoing assessment of patients and family to provide timely and safe discharge planning
Assists with comprehensive discharge planning
Utilizes critical thinking to execute effective discharge planning. Utilization Management
Conducts medical necessity review for appropriate utilization of services from admission through discharge
Promotes effective and efficient utilization of clinical resources
Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor
Other
Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
Serves on Hospital and Division committees when requested
Knowledge/Skills/Abilities/Expectations
Knowledge of government and non-government payor practices, regulations, standards and reimbursement
Knowledge of Medicare benefits and insurance processes and contracts
Knowledge of accreditation standards and compliance requirements
Must read, write and speak fluent English
Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software
Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers
Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members
Must have regular attendance
Approximate percent of time required to travel, 0%