Acute Care Coordinators are the first line clinical representatives for Kaelo in response to requests for emergency care and other acute care access. They are responsible for authorising access for the appropriate cases telephonically or per email. Acute Care Coordinators load all hospital related cases for emergency department treatment and initial admission into hospital. Candidates will be required to issue authorisations for GP visits when clinically appropriate when transferred from the call centre. The role is expected to communicate with the clients on the benefit availability and limitations and communicate with all members of the clinical team to ensure appropriate early care coordination.
This position reports to the Acute Care Team leader who reports to the Clinical Advisor.
Note: This job specification provides a general outline of the responsibilities and qualifications expected of an Acute Care Coordinator. Specific duties and requirements may vary depending on the organisation.
Acute Care Coordinator Responsibilities and Key Outcomes
Responsibilities include:
The candidate will be expected to work shift work from time to time on a rostered basis to facilitate the operations of a 24 hour clinical service centre.
1. Emergency Care Coordination
- Answering calls routed through for emergency department visits or hospital admission in the event of an emergency and provides appropriate authorisation.
- Review ambulance claims for appropriateness and correct Level of Care.
- Discussing diagnoses with doctors, specialists, and other health care providers.
- Respond to clinical enquiries from the first encounter.
- Receive calls from the call centre for members with consultations above the recommended annual limit and guide correctly based on clinical appropriateness.
- Conducting assessments of patient needs such as mental health issues or substance abuse problems and refer to EAP where applicable.
3. General
- Report any clinical escalations/concerns to the Clinical Review Committee.
- Maintain confidentiality in clinical conditions shared with her/him.
- Load specialist authorisations on request.
- Educate patients on benefits and limitations based on their plan option.
- Ensure that Service Level Agreements are met.
Key outcomes
- Utilize all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, and manage patients presenting to the emergency department.
- Thoroughly complete documentation utilizing the appropriate computer software in compliance with the approved policies and procedures.
- Maintain current nursing skills and knowledge base by attendance at workshops and seminars, completion of mandatory continued professional development, reading of professional journals, publications, and participation in professional organizations.
Qualifications:
REQUIRED
- Registered Nurse / Enrolled Nurse / ALS paramedic
- Degree / Diploma in Nursing
- 2 years hospital nursing experience would be beneficial.
- Medical Aid or Insurance industry experience will be an advantage.
- Knowledge of ICD and CPT codes.
DESIRED
- ICU / Theatre trained or experience is an advantage.
TECHNICAL SKILLS OR KNOWLEDGE
REQUIRED
- Strong understanding of clinical codes.
- Health risk assessment knowledge.
- Computer Literacy.
Additional Information:
PERSONAL ATTRIBUTES: BEHAVIORAL COMPETENCIES
- Accountability for clinical decisions made.
- Communication with all related health care workers, patients, and next of kin involved in a case.
- Writing skills for clear and concise notes that are easy to understand.
- Efficient and effective mindset to make clear clinical decisions without prejudice and interfering personal beliefs.
- Planning and organisation of work.
- Resilient and adaptive to different environments.
- Prioritizes patient care.
- Self-development.
- Ethical, always maintaining professional image and language.
Remote Work: Employment Type:
Key Skills
Senior Care, Hoyer Lift, Medical office experience, Dementia Care, Home Care, Nursing, Alzheimer's Care, Administrative Experience, Meal Preparation, Medication Administration, Memory Care, Tube Feeding.