Medical Care Coordinator I (002)

The Medical Care Coordinator I is a key associate at Hope Network whose primary responsibilities include:  Facilitates the care plan for the treatment episode, proactively monitors clinical quality, and facilitates timely discharge from the program. During the treatment episode, they coordinate the efforts of psychiatry, physiatry, psychology, nursing, PT, OT, SLP, Rec, SW, and integrate the family in the plan.   They are responsible to facilitate real time communication from the treatment team to the external Nurse Case Manager, insurance adjustor, and external physicians serving the patient.  They serves as an advocate and liaison for and on behalf of consumers' rights and benefits.   They evaluate, facilitate and monitor services and client progress in relationship to established goals and objectives.

 

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
This is not intended to be an exhaustive listing of job functions.  This job description is in no way states or implies that these are the only duties to be performed by this employee.  The employee is required to follow any other instructions and to perform any other duties as assigned by management as long as the duties are lawful, ethical, and within best business practices.

 

1. Regular and predictable attendance is an essential requirement of this position.

 

2. Responsible for a smooth intake process for each new consumer assigned to their case load including:
• Ensure the consumer is assigned a complete treatment team as determined by their needs and physician orders and that their schedule is complete; 
• Address any admission day medical, personal care, and rehabilitation needs;
• Verify that all priority evaluations are completed and findings are implemented to ensure a safe and comfortable transition for the consumer;
• Complete all required intake documentation;
• Obtain copies of all necessary documents for invoicing of services including identification, insurance plan, insurance cards and legal forms if not yet received 

 

3. Responsible to oversee the medical care of the consumer by:
• Work cooperatively with nursing and direct care staff; and
• Ensure medical follow-up and care is provided including but not limited to scheduling and coordinating medical appointments and transportation, securing medical orders and treatment prescriptions at required intervals, and attending medical appointments when appropriate.
4. Serves as the primary point of contact for outside parties such as physicians, rehabilitation nurses, adjustors, families/guardians, and other service providers.  Keep all external parties informed, at their desired level and frequency, of the progress being made in the program.  Portrays a positive, professional image of the program.

 

5. Coordinate with the treatment team to ensure that consumer programs are coordinated and outcome oriented showing movement through the continuum of care, as appropriate.  Challenge the treatment team if progress slows or goals are not being achieved.  Proactively escalates the case for review by a program manager/director when the case presents some challenge to achieving successful outcomes or meeting the predicted outcomes.
6. Makes internal referrals that allow HNNR new opportunities to serve a consumer who has either made progress and can benefit from additional services, or has developed previously unseen concerns that could be addressed by a referral to the appropriate professional.   

 

7. Leads the treatment team in a manner which is conducive to problem solving and cooperation.  Works with the team to develop a treatment plan that is functional, measurable and goal directed. Ensure differences of opinion among the HN treatment team are resolved before meeting with external stakeholders.

 

8. Ensures that extraneous information needed for decision making, planning and execution of plans is provided and available to all team members.  Able to generally represent the treatment plan and current issues during team meetings that either support the need for ongoing care or indicate discharge to less intensive services. 

 

9. Communicates urgent information in a timely fashion and in ways that ensure all team members, including external, receive the information needed in a timely fashion.  Utilizes multiple avenues of communication to guarantee all team members have received the information.  (Note – email is not considered received until it has been read therefore cannot be used for time sensitive communication.)

 

10. Oversees the consumer’s medical chart to ensure that information is updated in a timely fashion, physician scripts for services are current, and written documentation conforms to our licensing and accrediting requirements. Utilizes tools and alerts within the EMR to facilitate team communication.

 

11. Prepares reports that summarize the consumer’s treatment and plan as provided by the entire treatment team, and which can be presented to funders to request funding extensions for the consumer to continue services.  These reports include: Team Treatment Plans, Periodic Reviews and Discharge Summaries.  Follow prescribed formats and program requirements.  Prepare special letters as needed including letters of Medical Necessity.

 

12. Understands the common funding sources for our level of care including auto no-fault, commercial health, Medicaid MOU program, and worker’s compensation. Understands and can explain patient responsibilities based on funding mix and coverage, including family responsibility of copayments and deductibles.  Works with families to address collection issues.  Reviews financial reports by case load as provided by the Finance Department.

 

13. Works with Funding Specialist to determine funding parameters, and communicates the limitations to all involved parties.  Monitors team adherence to prescribed parameters.  This includes monitoring of services for those consumers admitted under per diem agreements to ensure appropriate service provision is maintained.  Researches unusual or limited funding situations and modifies program recommendations to best fit the availability of funding and desire of the financial guarantor while meeting the intended program outcome goal. 

 

14. Works closely with the social work department to ensure that a discharge plan is in place and community resources are secured.  Refers family adjustment issues and other appropriate concerns to the social work department. 

 

15. Provides a quality review of consumer schedules and program participation.  Ensures that all consumers on their case load are receiving the prescribed therapies and medical services at appropriate frequencies.  Works with scheduling to resolve any issues of under treatment.

 

16. Is responsible for the timely, accurate and complete collection of outcome data for their caseload as identified by program administration.

 

17. Provides organized and effective communication to internal and external sources both in written and verbal formats.

 

18. Works cooperatively with program administration to address quality concerns stated by consumers, families, and outside professionals.

 

Educational / Talent Requirements:
 Bachelor’s degree in Human Services, Social Work, or Psychology with two years of case management experience or relevant master’s degree with less than two years case management experience either pre/post master’s degree attainment. LLBSW, LBSW, LLMSW, LMSW preferred.
1. Demonstrated verbal/written communication skills.
2. Ability to interface effectively with professionals from outside agencies.
3. Ability to articulate and actively support the mission of the corporation to various audiences.
4. Excellent organizational and problem solving skills.
5. Valid driver’s license and driving record acceptable according to HN policy.
6. Ability to work with little supervision or direction.

 

 

 

Work Experience Requirements:
1. At least two years of experience in a health/human service field with an emphasis in rehabilitation preferred.
2. Experience coordinating care and facilitating communication between caregivers and families.
3. Demonstrated ability in creating accurate and detailed notes/records.
4. Demonstrated ability in leading a team and providing direction.
5. Demonstrated problem solving skills.

 

 

 

Equal Opportunity Employer
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