Discharge Planning Coordinator - Value Based Service Org - Full Time 8 Hour Days (Non-Exempt) ([...]

University of Southern California; Glendale (CA); On-site; USD 60,000 - 75,000; Full time

Job summary

University of Southern California is seeking a Care Coordinator to support the Case Management team in discharge planning and care transitions. The role collaborates with Case Managers and Assistants to communicate discharge plans to patients and families, ensuring appropriate post-acute services are arranged and documented.

The coordinator assists with complex case management activities, TOC, and post-hospital care coordination across inpatient and outpatient settings, under supervision of the

Qualifications

• High school diploma or equivalent required.
• Minimum 3 years of clinical experience.
• Experience with computer data entry and typing accuracy.
• Strong organizational and customer service skills.

Responsibilities

• Coordinate care in discharge planning and Transitions of Care (TOC) with the health care team.
• Assist with scheduling appointments and arranging transportation per policy.
• Collaborate with social workers and care team to meet psychosocial needs.
• Participate in interdisciplinary meetings and data collection for discharge planning.

Skills

Typing 40-55 WPM

Good organizational skills

Good customer service skills

3 years clinical experience

Experience with computer data entry

Education

High school diploma or equivalent

Job description

Overview

Provides department support for the Case Management team to facilitate discharge planning and ensure appropriate throughput. Works with Case Managers and Case Management Assistants to ensure discharge plans are communicated to patients and families and enables a positive patient experience with discharge process. Follows up post discharge with patients to ensure arranged post acute services are provided as ordered and patients are satisfied with discharge process and with agencies providing the services. Under the supervision of the ambulatory care manager, the care coordinator provides care coordination services required to meet an individual's health care needs to promote cost-effective, quality outcomes. Assists members of the health care team in the management of specific patient populations in the inpatient and outpatient settings. The care coordinator role assists the ambulatory care manager with the functions of complex case management, utilization management, quality management, discharge planning, and Transitions of Care (TOC) with the coordination of post-hospital care services, including transfers to an alternative level of care.

Essential Duties

• Clinical Care Coordination: Works with the ambulatory care management nurse to manage a case load, supporting up to 200 commercial outpatients; contributes to the Transitions of Care (TOC) process with coordination of post-acute services for specific populations in the outpatient setting; collects data from multiple sources and works with the ambulatory care management nurse to assess patient needs; collects data in collaboration with patient, family, physician, health care team and works with the ambulatory care management nurse to develop a plan of care; collaborates with the ambulatory care management nurse to ensure a specific plan of care is in place for all patients; assists with timely completion of delegated tasks; provides coordination of care such as scheduling members\' appointments and arranging transportation as outlined in policy and procedures; actively participates in interdisciplinary meetings and team huddles; answers phone calls from providers, facilities, or patients related to status and processing of requests; assists with data collection for ongoing discharge planning needs, documents changes in computer system under the direction of the ambulatory care management nurse; demonstrates collaborative working relationship with social workers to meet psychosocial needs; demonstrates collaborative working relationship with care team members, including pharmacy, behavioral health, field team, office staff, and facility staff.


• Patient Education: Assist health care team with identification of patient/family educational needs for discharge; inform patient/family of discharge plan and involve them in decision making regarding care; work with Transitions of Care process to deliver post-acute services addressing educational needs to ensure a safe discharge plan; work with patient/family to learn self-management methods for ongoing monitoring and treatment of chronic conditions.


• Resource Management: Proposes alternative treatment options to ensure a cost effective and efficient plan of care; identifies and creates solutions to remove barriers that may impede optimal patient care; complete case management care plans including delegated tasks and interventions that effectively prevent ER visits, hospital admissions, or readmissions; works with the ambulatory care management nurse to ensure InterQual or MCG concurrent reviews are completed upon hospital admission and every two days; participates in InterQual and/or MCG competency testing; completes assignments timely and communicates to appropriate care team members; prioritizes tasks under the direction of the ambulatory care management nurse; notifies the ambulatory care management nurse in a timely manner when unable to complete assigned tasks or for escalation of clinical issues; assists with duties and/or tasks as assigned.


• Perform other duties as assigned.

Required Qualifications

• High school diploma or equivalent


• 3 years clinical experience


• Experience with computer data entry


• Typing 40-55 WPM


• Good organizational skills


• Good customer service skills

Preferred Qualifications

• 2 years experience in an HMO/IPA/Managed care setting is preferred


• 1 year care coordination experience within the last three years preferred


• Office skills

Required Licenses/Certifications

• Fire Life Safety Training (LA City). If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)