Mercy Medical Center Clinton Inpatient Care Coordinator in Holyoke, Massachusetts
3030_1215 C/A I/P Psych Unit-1215
Expected Weekly Hours:
Facility: Providence Behavioral Health Hospital
The Inpatient Care Coordinator is responsible for providing direction and leadership to clinicians, discharge planners, case management staff, and unit coordinator(s) to promote successful patient progression, care coordination, and utilization review. In collaboration with other internal and external disciplines, the Inpatient Care Coordinator coordinates the care of patients from admission to transfer or discharge with the intentions of providing cost effective utilization of hospital resources while promoting quality care.
Job Description Details:
Provides supervision and direction to unit coordinator and/or other multidisciplinary team members including clinical, nursing, and case management staff in the prioritization of patient progression and utilization of resources.
Within 24 hours of admission or on first business day, uses discretion and independent clinical judgment in applying evidence-based criteria (e.g. InterQual) as well as Medicare regulations to coordinate and direct level of care and status determination on each assigned patient.
Assists in the review of admissions for appropriateness and placement on inpatient units and proactively develops and maintains contact with referral sources.
Within 24 hours of admission or on first business day, establishes estimated date of discharge (EDOD) on each patient and coordinates with clinical and case management staff to commence and prioritize discharge planning activities. Reports out on EDOD and discharge plans in multidisciplinary rounds and other hospital-wide or unit-based meetings as assigned.
Completes concurrent level-of-care and status reviews utilizing evidence-based criteria on commercial, managed Medicare, and Medicaid patients, as well as Medicare regulations so that all hospital days are covered/certified. Responds to requests from and communicates directly with payers for clinical information.
Direct unit coordinators to obtain information from medical record and collaborate with clinicians and/or multidisciplinary team members to obtain additional information to support authorization of care.
Proactively communicate to payers for authorizations, appropriate length-of-stay, and prevention of inpatient denials. Assist with appealing concurrent denials by communicating necessary information to payers.
Create and maintain work-list that identifies incomplete utilization reviews.
Coordinates peer-to-peer reviews with physician or other provider and payer.
Performs medical record reviews to ensure that clinical care and documentation meets medical necessity for level of care for admission and continuing care.
Collaborates with the Nurse Manager or Director on the hiring, corrective action, evaluation processes, development of goals and completion of performance appraisals for unit coordinators and/or other staff including but not limited to clinicians and case management staff as appropriate as well as employee relations issues/concerns.
Attends and facilitates high-risk length-of-stay (HRLOS) or other related meetings, proactively identifying and addressing barriers that might impede the progression of care for patients.
Attends and facilitates multidisciplinary rounds on assigned unit and communicates pertinent information to the appropriate members of the team both effectively and professionally.
Has an understanding of patient’s clinical trajectory and disease process and is able to report the clinical milestones that support the patients continued need for inpatient care.
Ensures the delivery of quality patient care, refers quality issues and poor utilization of services to the appropriate sources and documents avoidable days/delays in care.
Responsible/accountable for professional development and maintaining licensure for self and takes ownership for self-education.
Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities, ensure compliant, safe, and cost-effective delivery of care.
Provides professional consultation to patients and family, staff and employees regarding level of care determinations, patient stay options, financial considerations, and managed care principles.
Maintains absolute adherence to hospital and departmental policies and practices regarding confidentiality and patients' rights and demonstrates knowledge and support of the hospital's missions and values.
Communicates professionally with all internal and external customers to effectively manage all cases per established organizational standards.
Participates in Early-Late rotation schedule and assist with House Nursing Supervisor coverage as needed.
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
Current unrestricted Massachusetts license as a Registered Nurse, BSN strongly preferred.
Previous supervisory experience strongly preferred.
3-5 years Case Management experience preferred, hospital or community based.
Two or more years of experience working with patients with psychiatric and/or substance use disorders strongly preferred.
Ability to identify problems, determine alternative course of action, and simultaneously address and prioritize multiple patients, projects, demands and issues.
Willingness to be flexible, resourceful and creative in problem solving. Work is not standardized and requires a high degree of delegation and prioritization skills.
Ability to act independently, supervise and direct unit coordinator and other multidisciplinary staff to assure optimal patient outcomes.
A personal presence which is characterized by a sense of honesty, integrity, and caring with ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Trinity Health.
Exceptional interpersonal and relationship building skills to effectively collaborate with multiple stakeholders to obtain management, staff, and physician involvement and accountability in achieving specific patient outcomes.
Must possess excellent verbal and written communication skills, presentation skills, analytical skills, be well organized, and maintain a highly professional manner and appearance.
Demonstrated ability to operate in a collaborative, shared leadership environment.
Demonstrated high degree of self-motivation, assertiveness and goal-attaining capabilities.
Effective negotiation, persuasive, planning and verbal/written communication skills.
Ability to be flexible and adaptable to changing processes and schedule requirements.
Requires ability to work on an inpatient psychiatric or substance use disorder treatment setting. Exposure to patients with varying degrees of psychopathology and who may be potentially aggressive or assaultive; risk of injury exists from these patients. High levels of stress present on frequent basis.
Requires working on a busy, inpatient psychiatric or substance use disorder treatment unit which can present discomforts due to noise or other interruptions.
Requires ability to lift 5-10 pounds of laptop computer and associated mobile work devices.
Reports to the Director of Nursing, Providence Behavioral Health Hospital
Has supervisory responsibility for Unit Coordinator.
On CSS Unit : Has supervisory responsibility for Staff Nurses.
Has supervisory responsibility of patient progression and utilization review.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.
Trinity Health offers rewarding careers in a community environment with all the advantages of working at one of the nation's largest health systems. We provide high-quality, people-centered care in 22 states through our network of hospitals, facilities, community-based services, and continuing care locations - including home care, hospice, Program of All Inclusive Care for the Elderly (PACE), and senior living facilities. If you are looking for a rewarding clinical or administrative position, you'll find exceptional career possibilities, opportunities for advancement and a job with meaning at Trinity Health.
Trinity Health employs more than 131,000 colleagues across 22 states. We honor and embrace a diverse representation of people, ideas and backgrounds. Our dedication to diversity is evident in our commitment to training, education, recruitment, retention and development, as well as community partnerships and supplier diversity.
Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences and health practices of the communities we serve and to apply that knowledge to produce positive outcomes. We recognize that each of us has a different way of thinking and perceiving our world, and that our differences not only serve to unite us, but also lead to innovative solutions.