<b>Description:</b> <b>Job Summary:</b> <br><p>The Patient Care Coordinator is responsible for overseeing the management and coordination of care for the acute inpatient population. The PCC collaborates with rounding MAPMG Hospital Based Service Physicians, patient/family, nursing, utlization review and other members of the healthcare team to assure continuum of patient care progression for clinical and cost-effective outcomes. The PCC facilitates and coordinates with community providers and ambulatory case managers to assist with the appropriate level and transition of care for a safe discharge and preventing a re-admission.</p> <b>Essential Responsibilities:</b> <br><ul> <br><li>Completes an initial face-to-face assessment for every admitted member to identify discharge needs within 24hrs of admission.</li> <br><li>Document in KPHC and communicate the assessment outcomes to determine the appropriate transition plan with MAPMG physician healthcare team and patient/family.</li> <br><li>Active participant in daily Care Without Delay (CWD) rounds reporting on patient progression towards the established discharge plan.</li> <br><li>Review and document discharge plan in accordance with KP discharge planning documentation policies, facility policies, and regulatory requirements.</li> <br><li>Document any updates, care progression and barriers to discharge daily, and as indicated on assigned patients.</li> <br><li>Manage timeliness of care progression with physician and nursing staff to prevent avoidable delays and or days.</li> <br><li>Collaborate with Social Worker to coordinate, long-term care, assisted living, financial assistance, and other services, as required.</li> <br><li>Send referrals/communicate with in-network vendors for coordination of post-acute levels of care such as Home Health, DME, IV infusion, SNF, Sub-Acute and Acute Rehab.</li> <br><li>Timely identification, recording, and escalation of delays in care and barriers to discharge. Provide solutions to correct delays and recognize systemic patterns that require corrective action.</li> <br><li>Assure follow up appointments and referrals to ambulatory case manager for high-risk patient population are scheduled and communicated to patient/family prior to discharge.</li> <br><li>Observe all facility safety policies and procedures (infection control, Members Rights policies, and any regulatory requirements)</li> <br><li>Participate in Quality Assurance duties and implementation of programs to improve care Quality Indicators.</li> <br><li>Maintain professionalism with all duties in an effective and timely manner as directed or assigned by designated supervisor.</li> <br><li>Consistently work cooperatively with patients, patients representatives, facility staff, physicians, consultants, and ancillary service providers.</li> <br> </ul> <strong>Basic Qualifications:</strong> <u>Experience</u> <ul><li>Minimum of one (1) year in an acute medical/surgical/ED or critical care nursing area.</li></ul> <u>Education</u> <ul><li>Associate Nursing degree required.</li></ul> <u>License, Certification, Registration</u> <ul><li><p>This job requires credentials from multiple states. Credentials from the primary work state are required at hire. Additional Credentials from the secondary work state(s) are required post hire.<br> </p></li></ul> <ul><li>Registered Nurse License (Virginia) within 6 months of hire AND Registered Nurse License (Maryland) within 6 months of hire</li></ul> <p> OR <br> </p> <ul><li><p>Compact License: Registered Nurse within 6 months of hire</p></li></ul> <ul><li><p>Registered Nurse License (District of Columbia) within 6 months of hire<br> </p></li></ul> <ul><li>Basic Life Support<br> </li></ul> <strong>Additional Requirements:</strong> <ul> <li>Experience using an electronic medical record system</li> <li>Some awareness or knowledge of health/care reimbursement systems (Medicare Advantage, Commercial payer, Medicaid and CMS regulatory rules)</li> <li>Annually: Successful completion of PCC Assessment of Critical Skills, Passing score on inter-rater reliability.</li> <li>Must be able to effectively communicate with physicians, members and their family or representatives, and hospital staff.</li> <li>Ability to work independently and apply critical thinking skills for problem solving and decision making.</li> <li>Adheres to KP Employees Handbook and facility policies and procedures.</li> <li>Must have excllent time management skills to develop organized work processess in a high-volume envirornment with rapidly changing priorities.</li> <li>Intermediate computer skills (Microsoft Office Suite proficiency).</li> <li>Ability to tolerate and cope with ambiguity.</li> <li>Ability to pormote teamwork and to work effectively as a team member.</li> <li>Excellent verbal and written communication skills.</li> <li>Ability to interact/communicate effectively with key internal and external stake holders.</li> <li>Provide excellent customer service to promote excellence in the patient experience.</li> </ul> <strong>Preferred Qualifications:</strong> <ul> <li>Recent acute care, case management, or home health experience preferred.</li> <li>BSN preferred.</li> </ul> <p><strong>Notes:</strong></p> <p>Every other weekend; Alternating holidays</p><img src="https://www.jobg8.com/Tracking.aspx?W2DxsawsqoTv1cEdOTGdR9oABpP7mTkhf" width="0" height="0" />