Care Transition Coordinator II - 24-198

Hill Physicians Medical Group - Sacramento, CA

Sacramento, CA

Hospitals

About the position

The CTC provides advanced administrative support by facilitating pre and post-acute care needs to avoid readmissions and ER visits. Serves as a liaison between hospital clinicians, providers, vendors, nursing facilities and HPMG Care Management staff. Capable of handling nonclinical activities within the full scope of Inpatient, Welcome Home, and Case Management functions. Duties include processing authorizations for discharge needs, scheduling PCP and specialist appointments, coordination of care at the bedside and PCP offices, and referring patients to appropriate Case Management staff. Monitors and tracks issues received to assure timely resolution and feedback communication to the referral source.

Responsibilities

• Completes intake process - facesheet receipt, verifies eligibility and builds referral into authorization, attaches clinical records and routes authorization to appropriate clinical queue within TAT requirements.
• Verifies benefit details with the health plans.
• Calculates LACE score at time of admission and documents in the authorization.
• Assists nursing staff in obtaining clinical information from facilities and summarizes information for continuing nursing facility stays, processes letters as directed by the CCR/TOC nurses, and processes authorizations which require only administrative level of review.
• Serves as contact to receive and process authorizations needed to support timely discharge from hospital or nursing facilities and subsequently routes cases to the appropriate care team.
• Engages patient and caregivers upon admission to the hospital and throughout the hospital stay, discharge instructions, transition preparedness, follow-up appointments within 7 days of discharge, and care to assure the patient understands the treatment plan and is well prepared for transition to the next level of care, in coordination with the TOC/CCR nurse.
• Shares the treatment/discharge plan created by the TOC nurse with member and appropriately communicates information so the patient is well prepared for transition to the next level of care.
• Participates in physician/case management/concurrent review rounds as needed.
• Completes ad hoc health plan drilldown requests.
• Travels to hospitals in assigned regions in Sacramento, San Joaquin or the Bay Area, up to 100% of the time.
• Maintains client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.
• Performs other duties as assigned.

Requirements

• 3-5 years of related managed care experience required
• Working knowledge of medical terminology
• Ability to coordinate effectively with a variety of customers including members, providers, hospital and office staff, health plans, internal departments, community resources, and peers
• Ability to work independently as well as in a team environment
• Multi-tasking, ability to prioritize, and strong critical thinking skills
• Excellent organizational and communication skills and ability to meet timeframes
• Computer Experience: proficiency with routine applications including Microsoft Word and Excel, EHR and or web-based application
• Experience with CPT/ICD9/1CD10 codes preferred