What are the responsibilities and job description for the Care Transition Coordinator II - 25-42 position at Hill Physicians Medical Group?
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Job Description:
Performs a liaison function between HPMG clinical staff, physician offices, outside vendors and other members of the team to support care coordination. Facilitates timely coordination by serving as the single point of contact for coordination of outpatient member issues. Requests for assistance are received and are either resolved or re-routed to appropriate staff. Provides services such as: appointment making, IHMM referral (home physician visiting), and outpatient authorization processing for post discharge services not requiring clinical review. Monitors and tracks issues received to assure timely resolution and feedback communication to referral source.
Job Responsibilities
- Place outbound calls to members from risk reports to engage for care coordination team.
- Place calls to members following closure from complex case management at specific intervals to check status.
- Daily review and monitoring of hospital discharges.
- Assign cases to WH team as identified on hospital proxy list.
- Maintains Welcome Home log to alert for WHC totals.
- Oversees and reconciles all acute transitions of care.
- Receive and process Intensive Home Medical Management (IHMM) referrals.
- Manages a CM queue to monitor IHMM cases for updating and attach IHMM progress notes to AE CM case.
- Accesses clinical records in hospital EHR to provider for clinical staff review.
- Monitor Transplant cases that do not require complex CM services.
- Monitors SNP Inpatient and discharge stats, maintains SNP logs.
- Maintains Care Coordination SharePoint resource binder, SNP IDCT, VCT IDCT and SNP spreadsheets.
- Prepares SNP meeting packets, gathers clinical records for IDCT weekly meeting.
- Participates in IDCT rounds.
- Updates AE SNP cases with IDCT recommendations.
- Process authorizations for IHMM, Transplant, Palliative and others following department workflows or as directed by nursing staff.
- Assist nursing staff by obtaining and attaching relevant clinical information.
- Serves as point of contact for partners such as: Alere, HN, IHMM programs, etc.
- Monitor Alere reports and update member health notes as needed.
- Assist Special Needs Program (SNP) clinical staff by providing non-clinical support.
- Create and utilize databases and spreadsheets including ad hoc reporting.
- Prepare key indicator reports.
- Attend meetings as required by the Supervisor and serve as support in key projects.
- Prepare monthly and quarterly reports for Management.
- Manage multiple projects that support the department.
- Provide general administrative support for staff in absence of Administrative Assistant.
- Perform other duties as assigned by Supervisor and/or Manager.
- Support the interdisciplinary team approach to ensure effective resource utilization, as well as quality and cost-effective outcomes.
- Coordinate internal and external resources for the individual member.
Required Experience
- Medical terminology required.
- Experience using ICD9/CPT coding required.
- Computer Experience: Basic proficiency with routine applications including Microsoft Word and Excel.
- 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 team environment.
- Ability to conduct thorough research as it applies to systems and operations.
- Ability to interface with all levels of management.
- Ability to exercise discretion and independent judgment.
- Demonstrated project coordination skills.
- Multi-tasking and ability to prioritize and problem solve through critical thinking.
- Ability to contribute to cross-functional work groups both as a leader and participant.
- Ability to meet strict timeframes.
Required Education
- Medical Assistant or Nursing Assistant certification, or A.A. or Bachelor’s degree, with 3 years managed care experience preferred.
Additional Information
Salary: $29 - $33/hour
Hill Physicians is an Equal Opportunity Employer
Salary : $29 - $33
