Outpatient Care Coordinator supervises the day-to-day activities of the patient relations team of a healthcare organization to deliver patient liaison services and patient-centric care. Coaches staff on best practices for responding to patient and family questions, concerns, and issues. Being a Outpatient Care Coordinator facilitates collaboration with multi-disciplinary teams to make recommendations for improvements to the patient experience. Ensures that escalated problems are addressed and resolved. Additionally, Outpatient Care Coordinator provides and maintains up-to-date informational materials and resources for patients and families. Follows all applicable regulations regarding patient information privacy policies. May require an associate degree. Typically reports to a manager. Working team member that may validate or coordinate the work of others on a support team. Suggests improvements to process, is a knowledge resource for other team members. Has no authority for staff actions. Generally has a minimum of 2 years experience as an individual contributor. Thorough knowledge of the team processes. (Copyright 2024 Salary.com)
May be eligible for $3,000 sign on incentive
May be eligible for relocation assistance
May be eligible for tuition loan reimbursement
Under the direction of department leadership, the Care Manager provides services consisting of comprehensive care management, care coordination and care continuing care services. The Care Manager is accountable for a designated patient caseload/population and plans effectively in order to meet patient needs. The Care Manager is a support to providers and the multidisciplinary in facilitating patient care. The Care Manager strives to enhance the quality of clinical outcomes and patient satisfaction while managing the cost of care.
Essential Job Functions
• Supports and models behaviors
consistent with Billings Clinic’s mission, vision, values, code of business
conduct and service expectations. Meets all mandatory organizational and
departmental requirements. Maintains competency in all organizational,
departmental and outside agency standards as it relates to the environment,
employee, patient safety or job performance.
• Conducts initial and ongoing
assessments and chart reviews of each assigned patient to identify potential
and or actual barriers and care needs.
• Proactively screens and assesses
the acuity and transitional needs of each assigned patient.
Engages and collaborates with
patients, support systems and the multidisciplinary/healthcare team to
establish a plan of care that addresses the mutually identified needs of the
patient.
• Interventions and Care
Coordination
• Demonstrates
the ability to interpret clinical information and understand health care
treatment and systems.
• Supports
patients to ensure they can function to the best of their ability and maintain
optimal health related to their medical condition(s). Identifies and addresses
gaps in knowledge/understanding/education related to disease management.
• Participates
in the patient’s plan of care by interacting/collaborating with patients,
support systems, healthcare professionals and community and state agencies.
Serves as a liaison between hospital, clinic and community agencies to
facilitate the exchange of clinical and referral information.
• Identifies
high-risk patients through risk stratification tools and ongoing assessments
including ED utilization and hospitalizations to address the
medical/psychosocial/financial needs of patients and their support systems in
both hospital and ambulatory settings.
• Reinforces
goals of care and treatment plans with patients and support systems in order to
enhance patient and support system engagement.
• Coordinates
care conferences to support effective communication as needed.
• Helps
navigate the patient throughout the continuum of care.
• Effectively
collaborates and coordinates care with the Social Services Care Manager.
• Maintains
current knowledge of community resources and ancillary clinical services to
meet the needs of hospital, clinic and regional customers.
• Provides
information about available resources to patients and their support systems.
• Partners
with the multidisciplinary/healthcare team and the Social Services Care Manager
to guide/advocate placement to the appropriate Acute rehab, LTACH, SNF,
long-term care facility, assisted living facility, or Home Health Care, in-home
services, hospice, ancillary OP services and/or DME as clinically appropriate.
• Acts
as a clinical resource to the Social Services Care Manager.
• Understands
consultative disciplines and their role in patient care.
• Maintains
respectful and professional communication skills.
• Insurance and Utilization
Management
• Maintains working knowledge of CMS
requirements and readmission penalties.
• Maintains working knowledge of
insurance/payer benefits.
• Evaluation
• Monitors
the need for revisions in the plan of care and makes recommendations to the
multidisciplinary/healthcare team when indicated. Modifies the plan of
care/goals to reflect changes in patient or their support system status and
needs.
• Monitors,
evaluates and documents patient progress related to plan of care.
• Documentation
• Documents
accurately and in a timely manner in the Electronic Medical Record per program
guidelines.
• Utilizes
standards of professional practice in all documentation and communication
consistent with organization/department policy as well as the Board of Nursing
and ethical guidelines established and universally supported by the nursing
profession.
• Documentation
and patient information shall be secured and maintained in accordance with
Billings Clinic policy, HIPPA, state and federal guidelines.
• Safety/Quality Assurance/Risk
Management
• Identifies
service gaps and participates in hospital and department programs to address
and improve quality of care.
• Advocates
for marginalized or vulnerable populations by identifying cases of abuse and
neglect and appropriately involving risk management and regulatory agencies.
• Professional Accountabilities
• Participates
in continuing education, department planning, work teams and process
improvement activities.
• Maintains
current Licensure.
• Adheres
to department and organizational policies addressing confidentiality, infection
control, patient rights, medical ethics, advance directives, disaster protocols
and safety.
• Demonstrates
the ability to be flexible, open minded and adaptable to change.
• Maintains
competency in organizational and departmental policies/processes relevant to
job performance.
• Utilizes
standards of professional practice in all communication with patients, support
systems and colleagues consistent with the Board of Nursing and ethical
guidelines established and universally supported by the nursing profession.
• Performs
all other duties as assigned or as needed to meet the needs of the
department/organization.
• Inpatient Care Management
Specific
• Collaborates
with post-acute services, Ambulatory Care Managers and PCP’s to ensure
successful transition back to the
home environment. Makes appropriate Ambulatory Care Management referrals.
Anticipates those patients who may require more support after hospital
discharge and communicates these concerns.
• Utilizes
length of hospital stay, past utilization of resources and risk stratification
to identify patients at high risk for readmission.
• Interfaces
effectively with the Utilization Review department to stay current on patient’s
eligibility for admission, continuing stay, or readiness for discharge.
• Communicates
with medical staff, coordination team and nursing staff regarding
appropriateness of admission, need for continued stay and discharge plans.
• Identifies
and records episodes of avoidable days.
• Evaluates
the appropriateness of care delivery in the inpatient setting and communicates
any discrepancies with the medical team.
• In
addition to the above Care Managers in the Emergency Department will also be
responsible for the following duties:
• Screens
ED admissions using established criteria for specific payer populations
• Understands
insurance/payer policy language, benefits and authorization requirements for
admission
• Discuss
payor criteria and issues on a case-by-case basis with clinical staff
• Ensures that the patient is in
the appropriate “status” and level of care for the clinical condition.
Utilizing screening criteria and physician advisor, per department standards
• Outpatient Care Management
Specific
• Receives
referrals on patients being seen in the clinic (Primary Care, SDC, specialty
office, ancillary departments). Coordinates services for medical and
non-medical care coordination needs that are episodic or longitudinal.
• Receives
referrals for elective procedure patients who would benefit from pre-discharge
planning assessments and resource coordination.
• Assists
patients through care transitions from hospital to home, SNF to home/assisted
living, or alternate setting per program guidelines.
• Manages
a panel of high-risk patients that require longitudinal education and support.
• Effectively
collaborates with Inpatient Care Managers and Social Service Care Managers to address
the needs of shared patients.
• Able
to function effectively as a part of a team. Utilizing shared knowledge to
address complex patient needs.
• Supports
Billings Clinic and community-based programs to advance the role of Outpatient
Care Management, strengthen partnerships and meet department and patient needs.
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