GENERAL SUMMARY: Acts with the goal of providing coordination and support to patients and their families/ care partners in transitioning from the acute hospital to a post acute community setting. Works in concert with the Care Coordination Department, Nurse Case Managers, Social Work Case Managers, and Clinical Navigators to ensure continuity of care, positive patient outcomes, and reduction of bed turnaround delays related to discharge planned to non-home settings. Effectively utilizes EMR. Obtains authorizations and updates statuses for discharge coordination when needed. Participates in quality assessment and continuous quality improvement activities. Works independently and incorporates positive patient experience tools and practices into their daily workflow. Performs all job duties and responsibilities in a courteous and patient-focused manner according to the Hurley Family Standards of Behavior.

SUPERVISION RECEIVED: Works under the direct supervision of the Director of Care Coordination and Clinical Risk Management and the Manager of Social Work and Social Throughput and Capacity Strain or their designees, who assign and review work for effectiveness and conformance with established policies and procedures.

MINIMUM ENTRANCE REQUIREMENTS:

• Bachelor’s degree in Healthcare Administration or related field -OR- Associate’s degree in a relevant field with 1 year of experience in a hospital setting.
• Ability to work independently, as well as collectively in a team environment
• Ability to make informed decisions in accordance with established policies and procedures
• Ability to organize, prioritize and complete competing tasks
• Excel under pressure and during stressful situations
• Must have excellent verbal and written communication skills with all members of the healthcare team.
• Ability to establish and maintain effective, harmonious working relationships with patients, patients’ families/care partners, physicians, staff, external agencies and the public.
• Possess comprehensive computer skills
• Ability to compile, analyze and evaluate data and prepare accurate reports from such data
• Possess working knowledge of medical terminology and hospital procedures
• Possession of working knowledge of prior authorization procedures and requirements preferred
• Possession of working knowledge of third-party payer fraud and abuse regulations preferred

1. Responds to needs for possible patient discharges to long-term care facilities, sub-acute rehabilitation facilities, assisted living facilities, boarding houses, or other post-acute settings that are not a return to the home the patient came from prior to hospitalization. Works with a sense of urgency and efficiency to expedite coordination of care and timely discharge.
2. Educates patients and their family/support persons with clear, concise and accurate information about their post-discharge choices within what is available and accessible with the resources present in each unique case. Regularly and consistently provides updates to the care team, the patient, and their support persons related to the progress of the plan.
3. Collaborates with the interdisciplinary team to ensure smooth and efficient transitions. Acts as a liaison between the Care Coordination Transitions team and the clinical healthcare team to ensure a coordinated approach to care.
4. Maintains clear and consistent communication with the clinical teams, case management team, patients, and patients’ family/support persons.
5. Utilizes the EMR system efficiently and effectively and provides clear, accurate and sufficient documentation of all actions taken.
6. Completes and monitors patient prior authorization activities as required by various payers for care coordination of discharge needs or placement.
7. Ensures timely processing of timelines of third-party insurance payers for prior authorizations and medical necessity justification purposes.
8. Obtains third-party authorization numbers as required. Documents information in patient records according to departmental policies and standards.
9. Operates office equipment including telephones, computers, copiers, fax machines, and other information processing equipment.
10. Maintains knowledge of all payer authorization guidelines, changes and updates in order to efficiently obtain timely approvals for service. This includes compliance with regulatory requirements and hospital policies and incorporation of all changes into their daily job functions.
11. Escalates case issues and unapproved authorizations through the appropriate EMR workflows and by telephone, as needed, to all appropriate parties.
12. Consistently works with teammates and leadership to help improve workflows, update processes and foster a positive workplace culture.
13. Performs other job duties as required/assigned. Utilizes new improvements and/or technologies that relate to the job assignment. Involvement in special projects as needed.