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Care Transition Coordinator Ii - 23-267

Company

Hill Physicians Medical Group
Address , Sacramento
Employment type FULL_TIME
Salary $28.63 - $32.19 an hour
Expires 2023-09-14
Posted at 9 months ago
Job Description
We’re delighted you’re considering joining us!
At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.
Join Our Team!
Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.
DE&I Statement:
At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.
We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!
:
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 as noted in the below “Essential Responsibilities” with a primary focus in one of these areas. Practices skills in the other two functional areas at least once a quarter or when asked of them. Duties such as: 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.
Job Responsibilities
Inpatient
  • Participates in physician/case management/concurrent review rounds as needed.
  • 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.
  • 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.
  • 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.
  • Travels to hospitals in assigned regions in Sacramento, San Joaquin or the Bay Area, up to 100% of the time.
  • Calculates LACE score at time of admission and documents in the authorization.
  • 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.
  • Performs other duties as assigned.
  • Completes ad hoc health plan drilldown requests.
  • Maintains client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.
  • Verifies benefit details with the health plans.
  • 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.
Welcome Home
  • Follows up and addresses any needs identified during outreach call.
  • Performs other duties as assigned.
  • Collaborates with interdisciplinary team via telephonic outreaches to support implementation of the identified discharge plan.
  • Completes ad hoc health plan drilldown requests.
  • Receives in-basket notification of discharge and/or identifies discharge from hospital EMR, calculates discharge LACE score and routes case to appropriate team member following episode creation.
  • Completes initial Welcome Home call to member within 36 hours for appropriate LACE score and refers high risk cases to Welcome Home nurse.
  • Uploads discharge summaries, medication list and other documentation to the Welcome Home episode in Epic.
  • Travels to PCP offices in assigned regions in Sacramento, San Joaquin or the Bay Area, at minimum once per quarter or as needed.
  • Maintains client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.
  • Makes PCP follow-up appointment as soon as possible after discharge with primary care doctor (and with specialists as needed) for a visit for not more than 7 days after discharge.
  • Sends letters externally as appropriate.
Case Management
  • Travels to PCP offices in assigned regions in Sacramento, San Joaquin or the Bay Area, at minimum once per quarter or as needed.
  • Makes PCP follow-up appointment as soon as possible after admission with primary care doctor (and with specialists as needed) for a visit for not more than 7 days after discharge, if applicable.
  • Performs other duties as assigned.
  • Maintains client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards.
  • Creates episode for referral to Case Management.
  • Runs LOH report, creates episode, makes initial outreach and refers case to health plan, Case Manager or Social Worker as deemed appropriate.
  • Offers education to member about Case Management services and available resources in coordination with Case Managers.
  • Outreaches to members for non-complex needs and updates chart notes.
  • Refers appropriate cases to designated staff as identified in workflows.
  • Completes ad hoc health plan drilldown requests.
  • Enters transition notes upon referral to designated staff. Collaborates with interdisciplinary team via telephonic outreaches to support implementation of the identified discharge plan.
Required Experience
  • 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
  • Computer Experience: proficiency with routine applications including Microsoft Word and Excel, EHR and or web-based application
  • 3-5 years of related managed care experience required
  • Ability to work independently as well as in a team environment
  • Experience with CPT/ICD9/1CD10 codes preferred
  • Multi-tasking, ability to prioritize, and strong critical thinking skills
  • Excellent organizational and communication skills and ability to meet timeframes
Required Education
High school diploma or GED
Salary Range
$28.63 - $32.19
Additional Information
Hill Physicians is an Equal Opportunity Employer