Clinical Care Coordinator - RN, PT or OT Lafayette PACE

FMOL Health; Lafayette (LA); On-site; USD 65,000 - 85,000; Full time

Job summary

FMOL Health is seeking a Clinical Care Coordinator for Lafayette PACE. The role collaborates with the care team and families to coordinate participant care and optimize resource use, under supervision of the Executive Director or designee.

You will monitor inpatient and emergency care utilization, facilitate discharge planning, and ensure adherence to quality and regulatory requirements while maintaining strong interdisciplinary communication.

Qualifications

• Bachelor's degree in RN/OT/PT (or equivalent).
• 3 years clinical experience with frail/elderly patients.
• Active unrestricted clinical license in the hire state (RN/PT/OT).

Responsibilities

• Coordinate care and resources with the PACE team and families.
• Oversee discharge planning from contracted facilities.
• Review hospitalization records with case managers and discharge planners.
• Provide daily updates to the PACE IDT and providers.
• Document updates in the EMR at each site.

Skills

Care coordination

Discharge planning

Interdisciplinary teamwork

Team communication

Regulatory compliance

Education

Bachelor's degree in nursing or OT/PT

Tools

EMR systems

Job description

Clinical Care Coordinator - RN, PT or OT Lafayette PACE

Lafayette, LA, United States and 1 more (On-site)

Job Description

The Clinical Care Coordinator works collaboratively with all members of the health care team and the participant/family to ensure coordination of participant care and resource utilization. Responsible for ensuring cost effective and quality participant care by appropriate utilization of contracted resources. Works under the direct and indirect supervision of the Executive Director or designee.

Care Management

• Monitors care provided by inpatient providers to assure participant care conforms to accepted practice standards. This primary includes emergency room and inpatient medical and psychiatric admissions as well as LTAC and SNF stays.
• Communicates with PACE team, caregivers and providers as well as contracted service providers to coordinate care, utilization and discharge planning while in a contracted facility.
• Oversees discharge planning from facilities and assures that a plan is developed and implemented as participants transition back to the community.
• Reviews emergency room and inpatient records and works with case managers, discharge planners and social workers to review utilization and care needs during hospitalization.
• Provides daily and as needed updates to the PACE IDT and providers on participants who are hospitalized.
• Completes the daily tracker for all PACE sites and distributes daily

Leadership

• Demonstrates active participation in Quality Assurance Performance Improvement processes.
• Conforms to regulatory, customer and organizational requirements.
• Oversees utilization quality plans as designated on the annual quality plan
• Complies with policies addressing safe working conditions; monitors unsafe working conditions; recognizes inappropriate and/or ineffective participant care management, resolves issue/problem and completes written reports.
• Maintains relationships with case managers and discharge planners and provides education on PACE services and regulatory requirements.

Interdisciplinary Team

• Works with team and the participant/family in developing or revising the plan of care; makes referrals to interdisciplinary support services at time of discharge from a contracted facility
• Records participant updates and discharge planning in the EMR.

Qualifications

• Education: Bachelor's degree (RN Degree, occupational therapy, physical therapy.)
• Experience: 3 years clinical experience and 1 year working with frail/elderly patients.
• Licensure/Certification: Active Unrestricted Clinical license required in the state of hire for RN, PT or OT.