Inpatient Coordinator

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers. When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. JOB SUMMARY Provides crucial operational support to the health plan's Utilization Management (UM) and Transition of Care team. The primary focus of this role is the management, reconciliation, and continuous daily updating of the inpatient admission census, ensuring accurate and timely data entry. Additionally, the Coordinator supports TOC workflows by gathering and reviewing clinical documentation (discharge summaries, progress notes, medical orders) and coordinating follow-up appointments and post-discharge services to ensure a safe and seamless care transition for health plan members. ESSENTIAL FUNCTIONS Daily Inpatient Census Management Data Entry and Reconciliation: Maintain, update, and reconcile the daily inpatient census within the health plan's system based on reports received from facilities (via EDI, provider portals, or direct communication). Status Tracking: Monitor discharges, facility transfers, changes in level of care (e.g., ICU to step-down/floor), and readmissions to ensure accurate length-of-stay (ALOS) tracking. Clinical Support Escalation: Promptly identify and notify clinical team members (review nurses and case managers) of new admissions or priority cases requiring concurrent review. Facilitate operational reports required by the Management team. Transition of Care (TOC) Operational Support Clinical Document Collection: Request, retrieve, and upload essential post-discharge clinical documentation into the plan system (discharge summaries, medication reconciliation forms, post-care plans) and providers and members portals. Initial Administrative Review: Verify the completeness and legibility of collected clinical documentation prior to escalating to upload into the systems. Post-Discharge Appointment Coordination: Assist in scheduling and confirming follow-up appointments with Primary Care Physicians (PCPs) or specialists, ensuring member confirmation prior to or immediately following discharge. Services & Vendor Liaison: Facilitate coordination with Home Health Agencies, Durable Medical Equipment (DME) vendors, and sub-acute facilities according to clinical team guidance. Communication, Quality, & Compliance Interagency Liaison: Serve as an administrative point of contact between the health plan, hospital discharge coordinators, and contracted providers. Accurate Documentation: Meticulously log all interactions, document transmissions and status updates within the health plan platform to meet internal auditing and regulatory standards. Process Improvement: Identify operational bottlenecks in hospital data collection or notification processes and propose workflow enhancements and elevate to the management team for resolutions and action plans EDUCATION Bachelor's Degree Associate's Degree EXPERIENCE Bachelor’s Degree with six (6) months of experience in similar activities, or Associate degree or Technical Course with at least two-three (2-3) years of experience in operational support activities. Experience within a health plan organization, hospital admissions or care coordination is preferred. LICENSES AND CERTIFICATIONS None required COMPETENCIES Action Oriented Manages Ambiguity It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company. Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees. We encourage Veterans and Disabled to Apply. #J-18808-Ljbffr