Post Date: 7/17/2008

Ref ID: Trisha Blair
Division: Healthcare

Job Title: Patient Care Coordinator
Location: Brooklyn, NY,
Job Term: Permanent, Full Time
Salary: DOE

Requirements:
NYS RN Licensure, 3-5 years experience in utilization management/performance improvement preferably in a managed care environment. Bachelors Degree preferred

Job Description:
The purpose of this position is to ensure that Health Plus members obtain timely, cost-effective quality care in the appropriate setting. Responsibilities include, but are not limited to, inpatient admission review, coordination of continuing stay and discharge planning, review of requests for pre-authorization of elective admissions and procedures. In all areas the Patient Care Coordinator is charged with managing the delivery of care in an effective, professional and compassionate manner. Specific Duties and Responsibilities Under the direction of the Health Services Clinical Supervisor/Health Services Associate Director, and in coordination with the Medical Director, the Patient Care Coordinator is responsible to apply the Nursing Process to review and evaluate all clinical services provided to members. Responsibilities include the following: · Tasks specific to Inpatient Concurrent Review assignment: Identifies, on daily basis, all Health Plus members who are currently hospitalized Prioritize the review of those patients according to the relevant Health Services Policy and Procedures Conducts initial inpatient review and determines the appropriateness of admission, anticipated length of stay and potential discharge needs Documents the inpatient review in the computer system including: diagnoses, procedures, attending physician, treatment plan, anticipated length of stay and needs utilizing accepted UM guidelines Performs concurrent review and enters information in the computer system in a timely manner an demonstrates participation in the discharge planning process to ensure timely discharge, appropriate follow up and continuity of care · Tasks specific to Outpatient Services assignment (Authorization and Pre-certification of ambulatory or outpatient services): Reviews and evaluates all requests for extramural referrals, outpatient procedures and ambulatory surgery according to Health Plus UM guidelines and the standards specified in the Health Plus Utilization Manual · Reviews and evaluates all requests for elective inpatient admission · Authorizes those inpatient and /or outpatient services that meet the health plan’s approved UM criteria and the policies in the Health Services P&P Manual · Promptly refers any case that does not meet approved UM standards or where there is a quality of care concern to the Medical Director for review · Assessment and coordination of referrals for inter-hospital transfers, specialty care, DME, Home Health Care and transportation · Assists the member in accessing services, including making appointments for members when appropriate and providing patient teaching and support to facilitate compliance with the treatment plan. Refers members to the Tele-Nurse Call Center for more extensive patient teaching as appropriate · Maintains current information in the computer system with an expected delay of two days (and maximum of five days) delay in the data entry of authorizations and discharge summary. Informs the Health Services Manager immediately if he/she anticipates a delay of longer than five days in data entry Please email or fax your resume to: Trisha Blair Direct Hire Recruiter 295 Madison Avenue, 8th floor New York, NY 10017 (p) 212-683-0680 (f) 212-697-3007 email address: tblair@staffingremedies.com

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