Description

JOB PURPOSE:
Under the supervision of the Manager of Utilization Management, the UM RN Clinical Care Coordinator Team Lead is responsible for providing daily oversight and hand-on leadership to the Care UM staff. The Clinical Care Coordinator proactively identifies and removes barriers that may impede department or system-wide patient flow by serving as a consultant and educator with medical staff regarding patient status, bed placement, payor requirements and utilization of resources. The Clinical Care Coordinator will work closely with Care-link to have a system wide view of the hospital, including 24/7 central coordination of patient admission, placement, flow, staffing and service department testing and procedures. The Clinical Care Coordinator will be required to utilize their extensive clinical knowledge in assessing, prioritizing and coordinating transfers into the health system. The Clinical Care Coordinator will act as the primary liaison between all service locations, support departments, other healthcare facilities and in partnership with physicians to ensure appropriate patient placement for effective, efficient patient-focused outcomes. Works collaboratively with all members of the healthcare team to improve length of stay (LOS) performance of the organization.

KEY RESPONSIBILITIES:
1. Onboard, train and provide day-to-day supervision for Care-link UM staff
2. Coordinate 24/7 coverage for UM staff in the Care-link office
3. Participate in Care-link process/planning meetings
4. Organize and lead education to physicians and case management staff related to utilization management, higher level of care transfers, CMS changes/updates and Commercial and Management Medicare updates
5. Review requests for transfer submitted to Care-link via Epic and/or telephonically to determine medical necessity and higher level of care need
6. Obtain pre-cert/authorization for urgent admissions
7. Perform eligibility and benefit reviews as necessary
8. Review emergency room admissions for medical necessity of admission to Observation and/or Inpatient
9. Review emergency room track board for out of network admissions
10. Assist the physicians and nursing staff with finding in network providers for patients requiring transfer out of the Piedmont system
11. Perform admission, concurrent and retrospective reviews as necessary
12. Facilitate peer to peer physician reviews and Secondary Physician Advisor referrals when necessary