Discharge & Care Coordination Specialist

Phoenix Children's; Gilbert (AZ); On-site; USD 60,000 - 90,000; Full time

Job summary

Phoenix Children's in Gilbert, AZ is seeking a Case Manager to provide comprehensive care coordination for assigned patients, assess plans of care, and support discharge planning within the Department of Case Management.

The role collaborates with the interdisciplinary care team to establish estimated length of stay, coordinate transitions, and advocate for patient and family needs while navigating payer requirements and resources.

Responsibilities

• Coordination of Care
• Manages a defined service line patient population to achieve optimal discharge and continuity of care outcomes in a manner that promotes sound financial stewardship and patient-family advocacy.
• Establishes estimated Length of Stay via MCG criteria and tools,
• Completes an initial screen of all patients on admission (not to exceed within 24 hours of admission) utilizing MCG criteria to identify needs related to care coordination and/or discharge planning.
• Leveraging MCG and other evidence-based guidelines, coordinates development and implementation of a comprehensive discharge care plan in collaboration with the clinical care team.
• Ensures plan of care is in place with all team members. Proactively collaborates with members of the interdisciplinary clinical care team to define and document a clear and comprehensive treatment plan, including post-discharge needs. Identifies and facilitates resolution of variances in the plan of care that may impact length of stay. Facilitates referrals to other disciplines, and monitors for appropriate follow-up.
• Facilitates and provides on-going communication with patient/family and escalates unresolved barriers to timely discharge to Case Management, Manager or Utilization Management Medical Director, as per department protocols.
• Reviews and analyzes third-party payer denials for in house patients, and communicates to attending physician , Case Management, Manager, Utilization Management Medical Director, and Utilization Management Nurse as per department protocols.
• Cultivates and maintains effective interaction/communication with members of the interdisciplinary care team and proactively engages patient and families in the delivery of care across the continuum of care.
• Reviews the patient daily for appropriate patient status , level of care and goal length of stay per established Case Management daily prioritization protocol , utilizing MCG criteria and communicates goal length of stay to clinical care team, patient and family.
• Keeps patient discharge information current in Case Manager EMR documentation. Assesses each patients status and activities daily as appropriate to patient needs. Ensures timeliness of care and identifies barriers to transition of care or discharge.
• Participates in interdisciplinary rounds and/or service line rounds with clinical care team.

Job description

Phoenix Children's in Gilbert, AZ is seeking a Case Manager to provide comprehensive care coordination for assigned patients, assess plans of care, and support discharge planning within the Department of Case Management.

The role collaborates with the interdisciplinary care team to establish estimated length of stay, coordinate transitions, and advocate for patient and family needs while navigating payer requirements and resources.