Care Coordinator

Transitions Of Care CoordinatorThe Transitions Of Care Coordinator uses a multidisciplinary approach to ensure that SE participant transitions of care to and from inpatient facilities are appropriate, timely, and successful. In collaboration with the SE IDT ascertains that participants are in receipt of high quality cost efficient care and outcomesPrimary Job ResponsibilitiesAttends daily IDT meetings to discuss inpatients and suggest discharge plansUtilize a checklist to ensure that the components of a safe transition of care occurCommunicates daily with primary team members to address potential barriers to discharge or transition to lesser care settingParticipates in family meetings as neededParticipates in contracted facility case management meetings to address potential barriers/facilitate successful discharge planning.Collaborate with facilities, IDT members and others involved in participants plan of care to ensure safe, efficient transitions from facility to facility and to the home settingFacilitate pertinent record exchange to and from facilities for continuity of care and medication reconciliationActs as a liaison between facilities and IDT members to convey progressAccess resources out of network to meet participant needsUtilize Collective Medical to track transitions in real timeSupports the fundamental mission of the Summit ElderCare programDetermines tier of service at subacute facilitiesConduct concurrent and retrospective utilization review for inpatient, observation or SNF servicesRecognizes, identifies, and implements appropriate opportunities to help meet Utilization goalsKnowledge of managed care, quality, and risk management principlesParticipates in the SE Utilization CommitteeGenerate Ad Hoc request when requiredConcurrent and retrospective review utilizing a multitude of systems and electronic recordsEnters authorizations in applicable systems to ensure that claims are adjudicated efficientlyDocuments all inpatient care transitions and case management progress notes within the electronic health recordGenerate Transitions of Care Templates to accurately reflect transitions and level of careTrack Vendor DenialsIdentify quality/risk factors in continuum of care and report to Medical Director and Quality TeamUtilize clinical judgement and critical thinking to suggest alternative measures for provision of careEducationBSN or Associate of Science in Nursing, Bachelor of Science in Nursing.License/CertificationsLicensed by the Commonwealth of Massachusetts Board of Registration in Nursing as a Registered Nurse. Valid Driver's License CCM or similar certification desiredExperienceThree to five years nursing experience with one year experience working with a frail or elder population. Recent case management or utilization management experience and knowledge of criteria for medical necessity determination preferred. Must possess strong interpersonal, analytical and communication skills.Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.