To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Functions as a member of the health care team and is responsible and accountable for ensuring appropriate transition of care from initial point of contact through discharge. This staff member is responsible to proactively plan and develop solutions to unique and complex discharge processes in collaboration with the Care Management staff and health care team. Interaction with both external vendors, insurance companies, all members of the health care team, and the patient/responsible party are primary to the functioning of this position. The action of these staff members directly impacts the ability to discharge patients in a timely and safe manner, which impacts the hospital LOS and the delivery of quality patient care. In collaboration with the Care Manager this staff member is responsible for the flow of patients throughout their service on a daily basis and all necessary follow-up. Patient and family centered care (PFCC) at YNHH is demonstrated by working with patients and their responsible party based on the 4 principles of PFCC: participation, dignity and respect, information sharing, and collaboration. This includes providing Service Excellence by creating a great First Impression by demonstrating exemplary customer service skills for all customer groups including patients, their responsible party, physicians, staff and support department personnel. Adheres to the I Am YNHH service excellence pledge and promotes a positive work environment.
Responsibilities: 1. 1.Establishes a relationship with members of the health care team, patients and families to gather necessary information required to facilitate the acquisition of appropriate discharge resources. Explains the discharge process for Medicare regulations, understands and interprets insurance company rules and limitations, provides patient and family choice. Provides information about expectations for service, directs patients and families to appropriate sources to understand certifications and safety of homecare agencies and skilled nursing facilities. 2. 2.Coordinates the flow of communication of PHI under HIPAA guidelines to the appropriate healthcare provider or vendor. Assures all necessary information is documented and communicated to members of the healthcare team, and then is transferred to the next provider in a timely manner. Problem solves in shepherding staff to completion of their duties which facilitates timely discharge. 3. 3.Follows all state and regulatory requirements for the appropriate screening of patients for skilled nursing facilities. Interacts with homecare staff, on site nursing liaison staff and insurance personnel in a manner only congruent with the job expectations. 4. 4.Identifies potential patient complaint areas and resolves issue with appropriate parties. Refers issues for resolution to members of the health care team and/or Patient Relations as appropriate for service recovery. Maintains awareness of scope of role and consults with the appropriate staff to accomplish resolution of the issue. 5. 5. Remains fully aware of all vendors' array of services and provides patient/representative with necessary information if requested. Provides patient with choice while considering insurance in/out networks. Follows hospital corporate compliance guidelines to avoid case finding by agencies or enticements for referrals from hospital staff. 6. 6.Interacts with outside vendors in the maintenance of a relationship prior to and following hospitalization remaining cognizant of HIPAA regulations. 7. 7.Ensure skilled nursing facilities receive approved ASCEND paperwork and insurance authorization as necessary prior to discharge. 8. 8.Utilizes all electronic computer systems to aid in workflow. Utilizes Care Management program correctly to document referral activity, communication with vendors and placement process. 9. 9.Maintains relationships with SW, PFAS staff in remaining up to date regarding the patient's legal and financial status. Guides families to initiate and follow through on all T-19 applications and insurance validation. 10. 10.Participates in all Care Management activities including staff meetings, continued education, and ongoing workflow and process improvement initiatives. Demonstrates patient service excellence at all times.
Bachelor of Science Degree in Business Administration, Human Services, Health Administration or Social Work or other health care related field required.
Two (2) to three (3) years in a business health care environment with social work; third party payor; homecare or case management experience with proven strong customer relations experience.
Must be organized, able to prioritize and balance competing tasks working with many different individuals. Must be able to communicate and resolve issues. Self-direction and ability to proactively anticipate workload is imperative. Must be able to utilize the computer for Outlook communication, website research, excel spreadsheets, and faxing.
Accountable for hospital and department goals achievement related to LOS, time of discharge, compliance with patient rights/HIPPA. Must maintain excellent working relationships with all vendors and healthcare team members.
Requires ability to apply skills in diverse areas related to problem solving, use of resources, conflict management, utilizing judgment when dealing with patients/families, all other members of the health care team and third party payors and vendors. Continually formulates new ways to solve complex problems. Is open and participates in evaluating new workflow process by identifying inefficiencies and developing a swifter flow. Able to interact with the healthcare team in positive and productive manner, offering solutions to common problems. Committed to the development of positive interpersonal work relationships in a high pressured, fast paced and ever changing healthcare environment.