Care Transition Coordinator II, Care Management - 26-59

Job Description The CTC provides advanced administrative support by facilitating pre‑ and post‑acute care needs to avoid readmissions and ER visits. Serves as a liaison between hospital clinicians, providers, vendors, nursing facilities and HPMG Care Management staff. Handles non‑clinical activities within the full scope of Inpatient, Welcome Home, and Case Management functions, focusing primarily on one of these areas while practicing the other two areas at least once a quarter or when requested. Duties include processing authorizations for discharge needs, scheduling PCP and specialist appointments, coordinating care at the bedside and PCP offices, referring patients to appropriate Case Management staff, and monitoring and tracking issues received to ensure timely resolution. Job Responsibilities Inpatient Completes intake process – receives face sheet, verifies eligibility and builds referral into an authorization, attaches clinical records and routes authorization to the appropriate clinical queue within TAT requirements. Verifies benefit details with the health plans. Calculates LACE score at time of admission and documents it in the authorization. Assists nursing staff in obtaining clinical information from facilities, summarizes it for continuing nursing facility stays, and processes letters as directed by the CCR/TOC nurses. Serves as contact to receive and process authorizations needed to support timely discharge from hospital or nursing facilities and routes cases to the appropriate care team. Engages patient and caregivers upon admission to the hospital, providing discharge instructions, transition preparedness, and follow‑up appointments within 7 days of discharge. Shares the treatment/discharge plan created by the TOC nurse with the member and appropriately communicates information so the patient is well prepared for transition to the next level of care. Participates in physician/case management/concurrent review rounds as needed. Completes ad‑hoc health plan drilldown requests. Travels to hospitals in assigned regions (Sacramento, San Joaquin or the Bay Area). Maintains client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards. Performs other duties as assigned. Welcome Home Receives in‑basket notification of discharge and/or identifies discharge from hospital EMR, calculates discharge LACE score and routes case to the appropriate team member. Uploads discharge summaries, medication list and other documentation to the Welcome Home episode in Epic. Completes initial Welcome Home call to member within 36 hours for appropriate LACE score and refers high‑risk cases to a Welcome Home nurse. Follows up and addresses any needs identified during the outreach call. Sends letters externally as appropriate. Collaborates with interdisciplinary team via telephonic outreaches to support implementation of the identified discharge plan. Schedules PCP follow‑up appointment as soon as possible after discharge (within 7 days). Completes ad‑hoc health plan drilldown requests. Travels to PCP offices in assigned regions at least once per quarter or as needed. Maintains client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards. Performs other duties as assigned. Case Management Creates episode for referral to Case Management. Runs Length‑of‑Hospital report, creates episode, makes initial outreach, and refers case to health plan, Case Manager or Social Worker as appropriate. Outreaches to members for non‑complex needs and updates chart notes. Offers education to member about Case Management services and available resources in coordination with Case Managers. Refers appropriate cases to designated staff as identified in workflows. Enters transition notes upon referral to designated staff. Collaborates with interdisciplinary team via telephonic outreaches to support implementation of the identified discharge plan. Makes PCP follow‑up appointment as soon as possible after admission (within 7 days) if applicable. Completes ad‑hoc health plan drilldown requests. Travels to PCP offices in assigned regions at minimum once per quarter or as needed. Maintains client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory and accreditation standards. Performs other duties as assigned. Required Experience 3‑5 years of related managed care experience. Working knowledge of medical terminology. 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 a team environment. Multitasking, prioritization, and strong critical thinking skills. Excellent organizational and communication skills, and ability to meet timeframes. Computer experience: proficiency with routine applications including Microsoft Word and Excel, EHR and/or web‑based application. Experience with CPT/ICD9/ICD10 codes preferred. Required Education High school diploma or GED. Salary $30 – $34 Hourly. Hill Physicians is an Equal Opportunity Employer. #J-18808-Ljbffr Hill Physicians Medical Group