The Care Coordinator- Onsite plays an integral role in optimizing patients recovery journeys. The Care Coordinator- Onsite completes weekly functional assessments and engages the post-acute care (PAC) inter-disciplinary care team to coordinate discharge planning to support the members PAC journey. The position engages patients and families to share information and facilitate informed decisions. By serving as the link between patients and the appropriate health care personnel, the Clinical Review Coordinator- Onsite is responsible for ensuring efficient, smooth, and prompt transitions of care.

Primary Responsibilities:

By serving as the link between patients and the appropriate health care personnel, the Care Coordinator- Onsite is responsible for ensuring efficient, smooth, and prompt transitions of care

Perform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and utilizing CMS criteria upon admission to SNF and periodically through the patient stays

Review target outcomes, and discharge plans with providers and families

Complete all SNF concurrent reviews, updating authorizations on a timely basis

Collaborate effectively with the patients health care teams to establish an optimal discharge The health care team includes physicians, referral coordinators, discharge planners, social workers, physical therapists, etc

Assure patients progress toward discharge goals and assist in resolving barriers

Participate weekly in SNF Rounds providing accurate and up to date information to the HandC Transitions Sr. Manager or Medical Director

Assure appropriate referrals are made to the Health Plan, High-Risk Case Manager, and/or community-based services

Engage with patients, families, or caregivers either telephonically or on-site weekly and as needed

Attend patient/family care conferences

Assess and monitor patients continued appropriateness for SNF setting (as indicated) according to CMS criteria

When HandC Transitions is delegated for utilization management, review referral requests that cannot be approved for continued stay and are forward to licensed physicians for review and issuance of the NOMNC when appropriate

Coordinate peer to peer reviews with HandC Transitions Medical Directors

Support new delegated contract start-up to ensure experienced staff work with new contracts

Manage assigned caseload in an efficiently and effectively utilizing time management skills

Enter timely and accurate documentation into coordinate

Daily review of census and identification of barriers to managing independent workload and ability to assist others

Review monthly dashboards, readmission reports, quarterly, and other reports with the assigned Clinical Team Manager, as needed, to assist with the identification of opportunities for improvement

Adhere to organizational and departmental policies and procedures

Maintain confidentiality of all PHI information in compliance with HIPPA, federal and state regulations, and laws

Complete cross-training and maintain knowledge of multiple contracts/clients to support coverage needs across the business

Keep current on federal and state regulatory policies related to utilization management and care coordination (CMS guidelines, Health Plan policies, and benefits)

Adhere to all local, state, and federal regulator

UNITED HEALTHCARE SERVICES INC

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Care Coordinator Onsite