The Patient Care Coordinator is responsible for overseeing the management and coordination of care for the acute inpatient population. The PPC collaborates with rounding MAPMG Hospital Based Service Physicians, patient/family, nursing, utilization review and other members of the healthcare team to assure continuum of patient care progressions for clinical and cost-effective outcomes. The PCC facilitates and coordinates with community providers and ambulatory case managers to assist with the appropriate level and transition of care for a safe discharge and preventing a re-admission.
Responsibilities: -Completes an initial face-to-face assessment for every admitted member to identify discharge needs within 24 hours of admission. -Document in KPHC and communicate the assessment outcomes to determine the appropriate transition plan with MAPMG physician healthcare team and patient/family. Review and document discharge plan in accordance with KP discharge planning documentation policies, facility policies and regulatory requirements. -Send referrals/communicate with in-network vendors for coordination of post-acute levels of care such as Home Health, DME, IV Infusion, SNF Sub-Acute and Acute Rehab.
Requirements: Associate Nursing Degree 1 year in an acute medical/surgical/ ED or critical care nursing area Experience using an electronic medical record system Knowledge of health/care reimbursement systems (Medicare Advantage, Commercial payer, Medicaid and CMS regulatory rules) Completion of PCC Assessment of Critical Skills