[Hiring] Care Management Coordinator @TriHealth

Role Description

The Care Management Coordinator is responsible for overseeing the processes and documentation that occur as evidence-based practice is applied at the bedside. Directs and or completes all functions of the government and commercial utilization management process. Assesses and coordinates implementation of the discharge plan. Collaborates with the multidisciplinary team to assure effective, efficient, appropriate care in order to optimize the health status and assure a smooth transition between levels of care for patients served. Performs utilization review for patients served. Requires weekend, holiday, and off-site commitment, with the exception of Hospice of Cincinnati.

Job Responsibilities

• Using current practice guidelines, assesses all patients, evaluating progress toward clinical goals and next level of care. Reassesses as clinical condition changes.
• Complete initial utilization review using Interqual criteria. Take follow up action to resolve the situation when criteria are not met by implementing and documenting according to the Utilization Review plan.
• Coordinate the development of a comprehensive plan of care through patient/family involvement in an interdisciplinary team process. Ensure the patient's health care goals are met related to evidenced based quality care.
• Ensure that all commercial and government payment requirements are met for continued stay reviews, and other conditions of participation. Ensure that CMS requirements are met for patient status.

Qualifications

• Associate's Degree or Diploma in Nursing
• Hires into position (internal and external) required to obtain BSN within 5 years of hire
• BLS/CPR (Basic Life Support for Healthcare Providers)
• Registered Nurse
• Excellent communication skills
• Ability to negotiate
• Problem solve
• Establish effective working relationship with members of the healthcare team and external customers
• Knowledge & experience in computer key boarding
• Professional organization membership preferred
• 3-4 years’ experience Clinical in Nursing

Requirements

• Weekend, holiday, and off-site commitment required, with the exception of Hospice of Cincinnati.

Benefits

• Comprehensive benefits package, including medical, dental, vision, paid time off, retirement plans, and tuition reimbursement.

Working Conditions

• Climbing - Rarely
• Concentrating - Consistently
• Continuous Learning - Consistently
• Hearing: Conversation - Consistently
• Hearing: Other Sounds - Consistently
• Interpersonal Communication - Consistently
• Kneeling - Occasionally
• Lifting <10 Lbs - Frequently
• Lifting 50+ Lbs - Occasionally
• Lifting <50 Lbs - Frequently
• Pulling - Frequently
• Pushing - Frequently
• Reaching - Occasionally
• Reading - Consistently
• Sitting - Frequently
• Standing - Frequently
• Stooping - Occasionally
• Talking - Consistently
• Thinking/Reasoning - Consistently
• Use of Hands - Consistently
• Color Vision - Consistently
• Visual Acuity: Far - Consistently
• Visual Acuity: Near - Consistently
• Walking - Frequently

TriHealth SERVE Standards and ALWAYS Behaviors

• Serve: ALWAYS…
  • Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
  • Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
  • Refrain from using cell phones for personal reasons in public spaces or patient care areas
• Excel: ALWAYS…
  • Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
  • Offer patients and guests priority when waiting (lines, elevators)
  • Work on improving quality, safety, and service
• Respect: ALWAYS…
  • Respect cultural and spiritual differences and honor individual preferences.
  • Respect everyone’s opinion and contribution, regardless of title/role.
  • Speak positively about my team members and other departments in front of patients and guests.
• Value: ALWAYS…
  • Value the time of others by striving to be on time, prepared and actively participating.
  • Pick up trash, ensuring the physical environment is clean and safe.
  • Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
• Engage: ALWAYS…
  • Acknowledge wins and frequently thank team members and others for contributions.
  • Show courtesy and compassion with customers, team members and the community.