Patient Care Coordinator

Work Shift Weekend Option Scheduled Weekly Hours 40 Summary This position supports Mercy's philosophy of patient centered care acting as an advocate to patients and their families. The Patient Care Coordinator works specifically with patients experiencing complex disease processes needing multiple sources of health care support. The Patient Care Coordinator provides clinically based holistic care coordination and discharge planning in the inpatient and outpatient setting. Job Description Job Duties Complex care review of patient status Develops an understanding of referral sources for assigned caseload Collaborates with other programs and departments Assists in the teaching needs for patient and families as needed Ability to work with a variety of personalities, character or ability Serves as a liaison between physicians and departments to ensure timely and quality care delivery Conducts peer to peer reviews with third party payors when necessary to ensure reimbursement. Follows Mercy's safety guidelines, carries out job-specific safety duties and responsibilities, and promptly reports any unsafe conditions, situations, incidents and injuries. Department Specific Duties Behavioral Health Unit Communicates daily with physicians and clinical staff regarding the plan of care and progress towards goals Co-facilitates care conferences on assigned unit Provides clinical data/information to contracted third party payors while patient is hospitalized to ensure continued reimbursement and to avoid reimbursement delays. Identifies appropriate cases for appeals, formulates written appeals letters, and requests HIM to forward letters and needed documentation to third party payor Collaborates with care team to identify patients needing prior authorizations for medications. Completes and submits all required documentation Collaborates with care team to identify patients in need of county funding and assists patients and/or families to complete applications and ensure its transmissions to appropriate county office for processing. Ensures appropriate admission status has been documented applying DSM5 criteria and communicates effectively with physicians per utilization review process. Applies DSM5 criteria for continued stay review to effectively manage length of stay and communicate effectively with commercial insurance reviewers. Completes case management assessment of patients and support systems in order to facilitate the most appropriate and timely transition plan. Care Coordination Communicates daily with physicians and clinical staff regarding the plan of care and progress towards goals Co-facilitates care conferences on assigned unit Ensures appropriate admission status has been documented applying InterQual Criteria and communicates effectively with physicians per Utilization Review process. Applies InterQual criteria for continued stay review to effectively manage length of stay and communicate effectively with commercial insurance reviewers. Provides clinical data/information to contracted third party payers while patient is hospitalized to ensure continued reimbursement and to avoid reimbursement delays. Completes case management assessment of patients and support systems in order to facilitate the most appropriate and timely transition plan. Seeks patients eligible for admission to the Transitional Care Unit and other appropriate referral organizations. Knowledge, Skills and Abilities Sound background in complex nursing principles and procedures and demonstrated ability to provide safe and effective nursing care. Ability to communicate well orally and in writing; via phone, email and face to face; establish rapport with clients/patients. Self-starter; able to initiate and direct own activities in an organized manner and make decisions within the framework of the responsibility and authority of the job. Knowledge of utilization management process, discharge planning and managed care processes is a plus. Professional Experience Previous nursing experience required; case management experience preferred. Working knowledge of healthcare insurance, Medicare and Medicaid is preferred. Education A baccalaureate degree in nursing, current certification in patient population or relevant experience in lieu of a degree required. Licensure, Certification, Registration Basic Life Support (BLS) in accordance with the American Heart Association required. Current RN license to practice as a Registered Nurse in the state of Iowa required. Iowa Dependent Adult Abuse/Iowa Child Abuse Mandatory Reporter training required. Employee must submit certification of completed training to Human Resources prior to start or transfer date. Pay Rate Type Hourly Mercy is an independent, community-based organization supporting the Cedar Rapids area for over 120 years. Mercy is an equal-opportunity employer. We value diversity, equity, and inclusion and therefore evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status, and other legally protected characteristics. Talent Tuesdays Walk-In Interviews at Mercy Cedar Rapids - 11:00 a.m. to 1:00 p.m. every Tuesday We welcome the chance to meet with you and share our current opportunities, including information on our exciting sign-on bonuses for select positions! Mercy Cedar Rapids is a growing healthcare system. We are mission-driven, locally managed, and committed to the professional and personal growth of our employees. No appointment necessary - just bring your resume! The Mercy Touch it's compassionate people taking care of patients and each other. And, at Mercy Cedar Rapids, there's something for anyone who wants to have an influence on their community and grow their career. We are proud of our mission-centered culture and our employees enjoy growth opportunities, supportive team members, a generous benefits package and more. 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