Hospital Transition Coordinator - Washington, DC/Northern Virginia (#0011)
Our client, a large health insurance provider in the Mid-Atlantic region, is currently looking for a Hospital Transition Coordinator to fill a full-time role in the Washington, DC/Northern Virginia area(s).
PURPOSE: Hospital Transitions Coordinator is assigned to a specific hospital, region or facility to which they are familiar and oversees the Care Transitions program, as follows:
1. Supports the Care Transition Program for targeted members, ensures the coordination and continuity of health care as patients transfer between different locations or levels of care
2. Accountable for improving coordination between patients, providers and caregivers through communication and follow up
3. Provides rapid triage to the appropriate Care Management Programs, including Primary Care Medical Home (PCMH), Case Management, Disease Management, wellness and medication reconciliation to best address ongoing health needs of the member
4. Performs concurrent review for CareFirst members in accordance with the length stay guidelines outlined for the Care Transitions Program.
5. Consults with the Medical Director for medical necessity determinations and appropriateness of care.
PRINCIPAL ACCOUNTABILITIES: Under the general direction of the Manager and Supervisors of the Care Transition Program, the incumbent’s accountabilities include, but are not limited to, the following:
Rapidly triages patients into one of three levels for the Care Transitions program.
? Understands the Care Transitions concept and protocols, can advocate for the member.
? Contemporaneously, identifies members for program participation based on program guidelines, analytics and using clinical judgment.
? Engages patients to participate in the Care Transitions program and establishes relationship and follow up plan for ongoing coordination and assessment
? Assures patient understanding of adequacy of support upon transition and knowledge of who to call if problem arises, collaborates with facility staff as necessary to close gaps when identified.
Implements an effective Care Transitions program for members identified as Band 1A, 1B, 1C.
? Meets with triaged members while hospitalized. Discusses and reviews the discharge plan, addresses member concerns, acts as a member advocate.
? Contacts hospital discharge planner, liaison, or case manager during the triaged member’s hospitalization. Discusses and reviews the discharge plan.
? Contacts identified CareFirst members post discharge and actively follow up to verify the transition plan and care connections.
? Coordinates necessary interventions when gaps in the transition plan are uncovered.
? Communicates with the PCMH when patients are attributed, to improve the care connections from another level of care. Assists those patients who do not have a primary care practitioner to select a PCMH for care coordination and improved outcomes.
? Primary role as coordinator/facilitator - proactively guiding members to the appropriate CareFirst programs and resources designated as best, to achieve program goals of reduced readmissions, cost-efficiency and quality outcomes.
? Ensures the transition of care from one setting to another for identified CareFirst members. Provides member centric interventions such as verifying appointments and coordinating medically necessary home health services.
? Proactively identifies, assesses, and coordinates health care services based on the member’s needs and benefits.
? Coordinates appropriate referrals for Care Management Programs, such as Case Management, Disease Management, Mental Health Services, Wellness and Medication Reconciliation and communicates with those referral sources to improve transition.
? Advises and offers assistance to members and providers for alternative settings of care.
Communicates and interacts professionally with physicians, other providers, and members.
? Builds and maintains a solid professional relationship with all of the targeted facilities and is proficient and knowledgeable about the Care Transition model. Communicates regularly with the Plan on the operational issues/concerns and barriers.
? Improves communication during transitions between providers, patients and caregivers to assure smooth hand offs
? Provide timely and accurate transfer of information as patients move from one level of care to another.
Requires a bachelor’s degree in Nursing or equivalent experience and must have 7-10 years of increasingly responsible hospital related experience working in Care Management, Discharge Coordination, Home Health, or Disease Management; must possess extensive knowledge of how to manage care delivery guidelines and systems. Proven care management experience is critical.
The incumbent must have excellent analytical and problem solving skills, excellent organizational, communication and coordination skills. The incumbent must have effective presentation, negotiation and influencing skills to interface with all levels of management and physician practices. The incumbent must be able to apply complex problem solving abilities to achieve problem and process solutions.
A current DC, MD, or VA Registered Nurse License is required.
MSN or CCM, and familiarity with web based software application environment
Prior to being submitted for consideration, all candidates must take (and pass) an online assessment test which will gauge aptitude on skills such as basic computer literacy, patient focus and management, verbal ability, and work focus.
Interested and qualified candidates should apply immediately!