The Emergency Department Care Coordinator will serve as a “gatekeeper” for patients being evaluated for admission/observation into the hospital setting. The Care Coordinator will apply InterQual or Milliman criteria offering appropriate status assignment to the attending provider for consideration. This role is key to prevention of inappropriate admissions and for proper status assignment.For those admissions that do not meet criteria, the Care Coordinator will provide appropriate documents, such as the Hospital Notice of Non Coverage (HINN’s), provide education to patient/family or caregiver and offer alternative care settings as appropriate. The Care Coordinator will act as an advocate, seeking options and services to meet an individual’s and family’s/caregiver’s comprehensive health needs through communication and available resources to promote quality cost effective outcomes. Successful outcomes cannot be achieved without specialized skills and knowledge applied throughout the process. These skills include, but are not limited to, positive relationship-building; effective written and verbal communication; negotiation; knowledge of contractual or risk arrangements; the ability to effect change, perform ongoing evaluation and critical analysis; end of life care planning and the ability to plan, organize and manage effectively. The Care Coordinator is a Registered Nurse acting as a liaison between the patient, family/caregivers, clinical team, providers andthird party payers in the coordination of continued care, both for patients seen in the Emergency Department as well as in the hospital.
Must have a current NYS RN license in good standing. Two years’ experience in a hospital setting preferred. Requires exceptional communication and collaboration skills to interact with Medical Staff, all department staff and Health Center/Medical Home management. Requires ability to problem solve effectively in complex situations in a fast-paced environment. Must have strong assessment and goal setting skills and project management skills. Must be able to take the lead in a confident and competent manner in emotionally demanding situations. Must be knowledgeable of community resources. Working knowledge of prevailing Federal and State regulations guiding the profession a plus; required within 6 months of hire. Working knowledge of intensity/severity criteria in common use. Collaboration, negotiation and mediation skills; and time management and prioritization skills required.
Familiarity with MS Word, Excel; and Internet use required; Familiarity with Meditech a plus, and will be required within 3 months of hire. PRI or Screen Certification preferred and will be required after successful completion of probation status. The Care Coordinator must demonstrate knowledge of funding sources (third party payer contracts and requirements), health care services, human behavior dynamics, the health care delivery and financing systems, and clinical standards and outcomes.