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Care Coordinator - CCP

  • Job ID: 531554755
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Children's Community Pediatrics
  • Department: Care Coord HP
  • Location: 11279 Perry Highway, Wexford PA 15090
  • Union Position: No
  • Salary Range: $25.89 to $44.39 / hour

Description

Children's Community Pediatrics is hiring a Full-Time Care Coordinator for the CCP Central Billing office in Wexford. After initial training, this position may work remotely. Travel for site visits required as needed. RN strongly preferred.

Purpose:

The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care referrals and authorizations.

Responsibilities:
  • Start discharge planning on admission and ensure DC documentation is completed and updated regularly.
  • Obtain all necessary authorizations for level of care including admission and continued stay.
  • Follow payer-specific requirements to obtain and document authorizations.
  • Document all Avoidable Days in CANOPY system.
  • Initiate acceptance of lower LOC when appropriate with assistance from billing office.
  • Use InterQual criteria to justify appropriate LOC (Skilled, Rehab, Home Care, DME, etc.) and obtain all necessary payer authorizations for post-acute care.
  • Ensure compliance with all payer and government regulations.
  • Take leadership role in concurrent denial process.
  • Develop alternative/multiple discharge plans in anticipation of patient need for post-acute services.
  • Attend Department meetings and Corporate Care Management Training sessions in order to maintain current knowledge of all payer and regulatory requirements, UPMC CM policies and procedures, community resources.
  • Proactively identify barriers to discharge and work with multi-disciplinary team to expedite care, monitor length of stay (LOS) and facilitate discharge.
  • Address complex clinical and social situations efficiently in order to avoid unnecessary delays in discharge.
  • Collaborate with patients, caregivers, internal/external healthcare providers, agencies and payers to plan and execute a safe discharge.
  • Perform clinical review on admission and/or continued stay using InterQual criteria to determine appropriate level of care (Inpatient, OBS, etc.)
  • Re-evaluate and revise discharge plan as patient clinical condition merits.
  • Obtain Consent to Appeal on Behalf of Member on all cases with concurrent denial.
  • Promote patient safety. Support CORE measures information for JCAHO requirements.
  • Serve as resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies and post-acute services coverage and availability.
  • Work with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedite discharge planning for patients who no longer require hospital services.
  • Work with Care Management Director, Physician Advisor, Attending Physicians and clinical team to obtain necessary information and documentation to support LOC.
  • Review medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination.

Qualifications

  • BSN or related Bachelors degree preferred.
  • 5 years clinical experience required.
  • Previous case management experience preferred.
  • Knowledge of healthcare financial and payor issues preferred.
  • Knowledge of state, local, and federal programs preferred.
  • Use of InterQual criteria preferred.

Licensure, Certifications, and Clearances:
  • Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR)

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

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