The Hospital Care Coordinator supports Chartered’s
care coordination model when enrollees are admitted to an inpatient facility. The Hospital Care Coordinator makes daily onsite rounds at their assigned facilities verifying medical necessity and assessing and planning for the members discharge. The Hospital Care coordinator works in partnership with the member, the family defined by member (inclusive of member support network), providers, health plan staff, appropriate government entities and community based organizations to facilitate the member’s
transition across care delivery sites, levels of care and between practitioners. The Coordinator promotes a member-centric approach assuring that members receive needed care and services at the right time and in the right place to assure an optimal outcome.
POSITION DUTIES AND RESPONSIBILITIES
Daily Hospital Rounds
The Hospital Care Coordinator makes daily rounds on all Chartered enrollees admitted to their assigned hospitals. The frequency of review of an individual care plan may be less than daily, once the members’ assessment and plan of care has been established.
Follow Hospital Specific Rules
The Hospital Care Coordinator identifies and follows the hospital-specific procedures for conducting onsite review and discharge planning, including wearing a Chartered Name Badge at all times.
Maintain Collaborative Relationship with Assigned Facilities
The Hospital Care Coordinator identifies key personnel with their assigned hospital who may be involved in facilitating the members discharge and develops collaborative working relationships. The titles of hospital individuals may vary and may include but not be limited to hospital discharge planner, social worker, utilization review staff and/or hospitalist.
Maintains Current Chartered Census Report
The Hospital Care Coordinator verifies members’ admissions and discharges every day and updates Chartered Medical Management Software system, ensuring all admissions and discharges are data entered by the end of each business day.
Verifies Admission Medical Necessity
The Hospital Care Coordinator uses Chartered’s approved medical necessity criteria to verify the medical necessity of the admission within 24 – 24 hours of admission.
Verifies Continued Stay Medical Necessity
The Hospital Care Coordinator continues to verify the medical necessity of the members’ continued stay until discharge.
Identify Current Chartered Plan of Care
The Hospital Care Coordinator contacts the applicable care coordinator team to identify an existing plan of care.
Completes Discharge Assessment
The Hospital Care Coordinator uses Chartered Assessment and Discharge Planning form(s) to complete an initial assessment of the members’ clinical status, possible disposition location(s) and needed resources. This assessment includes resources used upon admission, social, complex and disease management, community and behavioral health needs.
Completes Discharge Plan
Throughout the hospital stay the Hospital Care Coordinator works collaboratively with hospital personnel, the member and member’s family, and attending practitioners to facilitating a discharge plan, identifying and facilitating post discharge resources.
Identifies Community Agencies/Services
The Hospital Care Coordination maintains their knowledge of the District Contract community agencies and services and makes appropriate referrals when indicated.
Consults with Chartered Social Worker
The Hospital Care Coordinator consults with Chartered’s Social Worker to problem solve/identify economic, social and community resources to meet member’s needs.
Facilitates and Coordinates Transition
The Hospital Care Coordinator facilities the identification of member needs, coordinates the transition from the hospital to the disposition location, and coordinates disposition services such as home health care/DME, to support optimal functioning.
Forward Discharge Plan
The Hospital Care Coordinator transitions the care coordination responsibilities to the applicable Chartered Care Coordinator, including forwarding the Chartered Assessment and Discharge Plan.
Interprets Benefit Plan and Chartered’s Policies
The Hospital Care Coordinator maintains their knowledge of the member’s Benefit Plan and policies and provides interpretation of benefits to health care practitioners, the member and member’s family.
Authorizes Needed Services
The Hospital Care Coordinator authorizes discharge services ordered by the practitioner when authorization is required by Chartered.
Maintain Accurate and Complete Documentation
The Hospital Care Coordinator maintains accurate and complete documentation in the Medical Management System and on other tools and forms required for use. The Coordinator maintains a 95% accuracy rate on documentation audits.
The Hospital Care Coordinator responds to telephone inquiries from members, hospitals, and clients by providing information within one business day. All inquires and responses are documented in the Medical Management Information System.
Makes Referral of Cases to Medical Director
The Hospital Care Coordinator refers any cases not meeting medical necessity and/or with an inadequate discharge plan, and/or with identified quality of care issues to their supervisor and Medical Director.
The Hospital Care Coordinator maintains knowledge of HIPAA requirements and maintains the confidentiality of member and protected information at all times.
Consults with claims examiners
Hospital Care Coordinators are available to Chartered claim examiners to provide clarification of authorized services and or to review claims for medical necessity and benefit coverage.
Maintains confidentiality of Chartered propriety information
The Hospital Care Coordinator understands the Chartered propriety information is confidential and protects it at all times.
Preceptor and Training
The Hospital Care Coordinator serves as a preceptor to new staff members and participates in the orientation and training of new staff.
The Hospital Care Coordinator realizes that Hospital Care Coordination activities are part of the larger Quality Improvement process which is designed to improve member outcomes. To that end, the Manager follows protocols and instructions that support quantification of outcomes.
The Hospital Care Coordinator participates in continuing educational activities to maintain and improve their knowledge of care and disease management. As appropriate, the manager seeks certification in case management, care management and or disease management.
The Hospital Care Coordinator participates annually and more often as needed in the evaluation of the effectiveness of the programs and makes recommendations for program modification as appropriate
There may be times when enrollees require a service that is not under contract to Chartered. The Hospital Care Coordinator identifies potential options; successfully negotiates a fee for these services and coordinates with internal staff and external resources to arrange for the provision of services by the vendor.
As appropriate the Hospital Care Coordinator participates in community programs related to the provision of services to enrollees. (which may occur outside of normal business hours).
The Hospital Care Coordinator maintains professional behavior when performing their duties at all times. This includes and is not limited to treating others with respect and courtesy, compliance with practice standards, personally discussing perceived problems in a constructive and timely manner, recognizing and respecting the unique view points of team members, pursuing changes through appropriate channels, responding in a timely manner, accurately reporting events which present an opportunity for improvement.
KNOWLEDGE, SKILLS AND ABILITIES
Bachelor of Science degree in Nursing (BSN); MSN or MS in a related field preferred.
Current Registered Nurse’s license to practice nursing in DC, Maryland, or Virginia (Certified Case Manager (CCM), preferred).
Minimum of five (5) years recent clinical nursing experience.
Two (2) years of discharge planning, utilization review or case management experience.
Two (2) years of managed care experience.
Demonstrated ability to communicate with both clinical and non-clinical personnel across all levels of an organization.
Demonstrated ability to use Microsoft Office programs; experience with databases a plus.
Working knowledge of community resources.
Possess working knowledge of ICD-9, HCPCS and CPT4 coding.
Required to travel to facilities for on-site review.
Must be at corporate office for mandatory meetings and trainings, and other activities as requested by manager.
Maintain laptop, cellular phone, and beeper provided by plan.
Chartered Health Plan - 11 months ago