Continued Stay Coordinator

Responsibilities

The Continued Stay Coordinator is responsible for facilitating and coordinating continued stay eligibility determinations to ensure participants remain eligible for services under applicable regulatory, contractual, and organizational requirements. This role conducts periodic functional eligibility reviews, analyzes clinical and non‑clinical information, and collaborates with interdisciplinary teams to support timely, accurate continued stay decisions. The position plays a critical role in regulatory compliance, continuity of care, and audit readiness.

Essential Functions and Responsibilities

• Facilitate Continued Stay Reviews (CSRs) by making referrals to agencies for the Level of Care (LOC).
• Serve as case manager until certification is obtained for annual continuation of PACE services.
• Facilitate continued stay reviews in accordance with federal, state, and program‑specific eligibility requirements
• Conduct periodic functional eligibility reassessments using clinical documentation, assessments, and interdisciplinary input
• Collect, review, and analyze supporting medical, functional, and psychosocial information to determine continued eligibility
• Coordinate continued stay review schedules and ensure reviews are completed within required timeframes
• Prepare and maintain comprehensive eligibility documentation, determinations, and supporting rationale in designated systems
• Collaborate with interdisciplinary team members (e.g., clinical staff, care coordinators, social services, enrollment, compliance) to support continued stay determinations
• Identify and escalate potential eligibility risks, gaps, or changes in participant status that may impact continued stay
• Communicate continued stay outcomes, requirements, and next steps to internal stakeholders and, as appropriate, participants or authorized representatives
• Ensure compliance with regulatory standards, program contracts, and organizational policies related to continued stay and eligibility
• Support audits, reviews, and appeals by providing accurate documentation and responding to eligibility inquiries
• Maintain strict confidentiality of participant information in accordance with HIPAA and organizational standards

Travel: 0% to 2%

Knowledge, Skills, and Abilities

• Knowledge of continued stay review processes and functional eligibility requirements
• Familiarity with healthcare regulatory frameworks (e.g., Medicaid, long‑term care, or PACE‑related eligibility standards)
• Strong analytical skills with the ability to interpret clinical and functional information
• High attention to detail and accuracy in documentation and determinations
• Effective written and verbal communication skills, including explaining eligibility decisions clearly
• Ability to manage multiple cases, prioritize deadlines, and work independently
• Proficiency with electronic health records, case management, or eligibility systems
• Ability to exercise sound judgment and professionalism in complex or sensitive situations

Education and Experience

Required:

• High school diploma or equivalent
• Minimum of two years of experience in eligibility determination, continued stay reviews, utilization review, case management, or related healthcare roles

Preferred:

• Associate’s or Bachelor’s degree in healthcare administration, social work, nursing, public health, or a related field
• Experience supporting continued stay, utilization management, or regulatory eligibility reviews in a healthcare setting