Transition Coordinator/Case Management Dept

New London, CT
Mar 3, 2020

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Job Description

Overview

Functions as a member of the health care team & 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 Case Management staff and health care team.  Interaction with both external vendors, insurance companies, all members of the health care team & 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 L+M 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.

EEO/AA/Disability/Veteran

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.



EEO/AA/Disability/Veteran

Responsibilities

  • Establishes relationships with members of health care team, patients/families in order to gather necessary information which facilitates the acquisition of appropriate discharge resources. Provides information about expectations for service, directs patients and families to appropriate sources to understand certifications & safety of home care, SNF, LTAC, IRU, etc. Provides quality rating information per request.

 

  • Knowledgeable in Medicare/Medicaid regulations and able to understand, interpret and explain insurance company rules and limitations to patient & families. Offers patient/family choice of facility, home care provider, vendor.  Follows hospital corporate compliance guidelines to avoid case finding by agencies or enticements for referrals from hospital staff.
  • Coordinates 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. Follows all state and regulatory requirements for the appropriate screening of patients for skilled nursing facilities. Assures information is documented and communicated to healthcare team.  Provides approved ASCEND, insurance authorization to accepting facility. Interacts with home care staff, on site liaison staff and insurance personnel in a manner only congruent with the job expectations.
  • Remains aware of all vendors’ array of services and provides patient/representative with information; interacts with outside vendors in the maintenance of relationships, remaining cognizant of HIPAA regulations.
  • Utilizes all electronic computer systems to aid in workflow. Utilized Care Management Navigator correctly to document referral activity, communication with vendors and placement process.
  • Maintains relationships with SW, Financial Counselors, Patient Access, and Patient Relations; identifies potential patient complaint areas and resolves issues 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 any issues. 
  • Guides families to initiate and follow through on all Medicaid applications and insurance validation.

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.

 

Meets performance expectations for Customer Service, Teamwork, Resource Utilization, and Staff and Self Development as outlined in performance review.

Performs other duties as assigned or directed to ensure smooth operation of the department/unit.

Qualifications

Education:           Bachelors of Science degree in business administration, human services, health administration, SW or other health care related field required.

Experience:        2-3 years in a business health care environment with SW, 3rd party payer, homecare or Case management experience with proven strong customer relations experience.

Training:               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.

Licensure:           None

Other:  

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Job Info

Job: 15775

Department: Case Mgt Social
Category: ADMIN SUPPORT
Sub Category: GENERAL CLERICAL
Status: Full Time Benefits Eligible
Shift: D
Hours: 40

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