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SalarySummary
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 out patient setting.
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.
Department Specific Duties
- 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.
Physical Demand Requirements
- Light: Exert up to 20 lbs. of force occasionally and/or up to 10 lbs. of force frequently
Location: Mercy Medical Center - Cedar Rapids · Care Coordination
Schedule: Full Time, Day/Evening, 10a-8p
