Care Coordination Specialist, Senior - Case Management - Per Diem 8 Hour Days (Non-Exempt) (Non-Union)
University of Southern California (USC)
Location: Los Angeles, California
Internal Number: REQ20142124
Works with specific patient populations, promotes the achievement of optimal clinical and resource utilization allocation, facilitates appropriate lengths of stay and reimbursement for all hospital admissions in accordance with goals and objectives. Acts as a key informational and educational resource liaison for care coordination team. Works to develop organizational approaches to problem solving for the management of patient stays in the acute setting and the transition to home or post-acute care. Analyzes current systems, data and variances to identify opportunities for improvement. Works to promote quality, efficient care through collaboration with l service lines, patients and families. This position is responsible for the management of complex cases, outliers, readmissions and transitions of care.
Management for Improved Outcomes â¦ Oversees the management of specific patient populations across the continuum focusing on complex /high risk/ high cost/ and/or difficult placement patients. â¦ Manages cases with complex issues and outliers as identified by specific triggers and criteria from Care Coordination team â¦ Directs effective delivery of services with multidisciplinary team through patient care conferences. Collaborates with members of the team regarding the plan of care â¦ Serves as a resource to the entire care coordination team for the management of these patients â¦ Promotes timely interventions and multidisciplinary care conferences for specific patient populations â¦ Serve as patient & family advocate to achieve maximum patient satisfaction â¦ Manages activities associated with utilization management, care facilitation, discharge planning, denial management, DRG assurance facilitation. â¦ Facilitates learning experience of health care team members by formulating, implementing, and evaluating strategies for specialized staff education â¦ Works with physician leadership and interprofessional teams to develop clinical pathways and continuous care management programs â¦ Actively participates in clinical operational performance improvement and quality activities â¦ Identifies and plans strategies to reduce the length of stay and resource consumption. â¦ Works with health care team to develop measurement and feedback of performance indicators for cost, quality, service, and patient satisfaction â¦ Collaborates with care management team to assist with benefits and resource management for patients â¦ Assists with negotiation with payors and agencies to achieve re-certification or a more cost-effective alternative to care. â¦ Advocates for the patient and family maintaining availability to them as a resource to facilitate communication among providers â¦ Manages Transfer Back Agreements and Letters of Agreement related to inpatient transfers and placements.
Utilization Management, Financial Management and Quality Screening for assigned patients: â¦ Applies approved utilization acuity criteria (such as Interqual) to monitor appropriateness of admissions and continued stays as the basis for managing identified outliers and complex case management. â¦ Communicates with Business Office, Patient Access Center, Physician Advisor and /or third-party payors to facilitate covered day reimbursement certification as needed and discusses payor criteria and issues on a case by case basis with clinical staff (i.e. Peer to Peer) and follows up to resolve problems with payors as needed. â¦ Collaborate for appropriate resource and financial management which may include but is not limited to financial assistance coordination/referrals, entitlement program coordination/referrals, patient benefit coordination, assessment of working DRG and/or collaboration with Clinical Documentation Improvement team, assessment for appropriate usage of Health Care Resources/clinical cost efficiency. â¦ Educates hospital staff and physicians to the payor regulations to prevent denials. â¦ Analyzes clinical and resource data to identify areas where changes are needed related to clinical, financial, and satisfaction outcomes â¦ Collects and analyzes fiscal data, variance data, and outcome data relevant to target groups to promote quality improvement â¦ Serves as resource liaison for governmental regulations, and ethics/healthcare law. â¦ Complies with HIPPA and all privacy, safety, and confidentiality requirements and policies â¦ Acts as liaison to major customers including payors, outside resources, and third-party participants. â¦ Reviews denials, appeals, and avoidable days in order to develop improved processes â¦ Performs audits in conjunction with payor/hospital regulations â¦ Assists in responding to concurrent review/appeals and providing information as necessary to avoid denials for patient admission. â¦ Works with payers
Coordinates/facilitates patient progression throughout the continuum, Transitional Planning, Advocacy and Education: â¦ Collaborates with all members of the Interprofessional Team to identify and manage outliers. Monitors the patientâs progress, intervening as necessary for high-risk or difficult cases and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective. â¦ Addresses/resolves system problems impeding diagnostic or treatment progress with the observation population proactively identifies and resolves delays and obstacles to discharge â¦ Provide education as needed to staff, physicians, and patients for transitional planning needs â¦ Collaborates and communicates with interprofessional team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation â¦ Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge â¦ Refers cases and issues to appropriate personnel, i.e. Medical Director, Physician Advisor or RN Senior Director, in compliance with department procedures and follows up as indicated â¦ Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues, involving RN Manager as necessary. â¦ Documents relevant discharge planning information in the medical record according to Department standards â¦ Works with post-acute providers and the Keck Medical Center Post-Acute Performance Network to identify issues and understand barriers to quality post-acute care â¦ Work with Patient Navigators to create a seamless experience for Keck Medical Center of USC patients.
Clinical performance improvement, outcome management and quality activities: â¦ Uses data to drive decisions and plan/implement performance improvement strategies related to Clinical Care Coordination for assigned patients, including fiscal, clinical and patient satisfaction data â¦ Uses quality data to review readmissions identifying trends and working with teams to develop strategies to manage high risk groups. â¦ Collects delay for services and other Avoidable Day data for specific performance and/or outcome indicators and reports data through service lines and departments from the perspective of process improvement and quality outcomes. â¦ Participates in development, implementation, evaluation and revision of clinical pathways and other Clinical Care Coordination tools and serves as a member of the clinical resource/team, including participation of staff interviews/screening for hire. â¦ Educate the interprofessional team and physicians about clinical pathways/protocols and managed care principles â¦ Participate in the development of clinical pathways, best practice standard development, competency process, as well as participate in Joint Commission Standard Compliance, Federal/State/Local Regulatory Agency compliance, Core Measure Utilization/compliance, Patient Safety Compliance, Quality improvement initiatives â¦ Identifies at-risk populations using approved screening tool and follows established reporting procedures â¦ Monitors clinical and financial indicators (i.e. length of stay (LOS), outliers, readmissions post-acute service destinations, avoidable days) and ancillary resource use on an ongoing basis and takes action to achieve continuous improvement in both areas as viewed on Care Managementâs Dashboard
Collaborates with Senior Director of Care Coordination and associated managers to: â¦ Assist with conducting staff meetings and role-based meetings â¦ Serves as mentor to staff â¦ Facilitates open communication â¦ Promotes team approach to working environment
Other duties as assigned.
Req Bachelor's degree Degree in Nursing (BSN); or Master of Social Work and LCSW or LSW certification
Req 5 years Clinical hospital experience
Req Deep knowledge of case management regulations, payor landscape and post-acute care transitions in California.
Req Critical thinking skills and organization in prioritizing a workload of multiple tasks.
Req Organization/time management skills.
Req Excellent analytical, problem-solving, planning and evaluation skills.
Req Commitment to continuous quality improvement and results driven outcomes.
Req Requires knowledge of data entry into a database and the ability to analyze the information to improve care and outcomes.
Req Registered Nurse - RN (CA Board of Registered Nursing) Or Current valid LCSW or LSW certification
Req Certification - Job Relevant Current Accredited Case Manager Certification.
Req Basic Life Support (BLS) Healthcare Provider from American Heart Association
Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
The hourly rate range for this position is $53.00 - $87.45. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidateâs work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
USC is the leading private research university in Los Angeles—a global center for arts, technology and international business. With more than 47,500 students, we are located primarily in Los Angeles but also in various US and global satellite locations.
As the largest private employer in Los Angeles, responsible for $8 billion annually in economic activity in the region, we offer the opportunity to work in a dynamic and diverse environment, in careers that span a broad spectrum of talents and skills across a variety of academic and professional schools and administrative units. As a USC employee and member of the Trojan Family—the faculty, staff, students, and alumni who make USC a great place to work—you will enjoy excellent benefits, including a variety of well-being programs designed to help individuals achieve work-life balance.
What Information Do We Collect?
When you visit our website you may provide us with two types of information: personal information you knowingly choose to disclose that is collected on an individual basis and website use information collected on an aggregate basis as you and others browse our website.
Personal Information You Choose to Provide
We may request that you voluntarily supply us with personal information, including your email address, postal address, home or work telephone number and other personal information for such purposes as correspondence, placing an order, requesting an estimate, or participating in online surveys.
If you choose to correspond with us through email, we may retain the content of your email messages together with your email address and our responses. We provide the same protections for these electronic communications that we employ in the maintenance of information received by mail and telephone.
Website Use Information
Similar to other websites, our site may utilize a standard technology called "cookies" (see explanation below, "What Are Cookies?") and web server logs to collect information about how our website is used. Information gathered through cookies and server logs may include the date and time of visits, the pages viewed, time spent at our website, and the sites visited just before and just after ours. This information is collected on an aggregate basis. None of this information is associated with you as an individual.
How Do We Use the Information That You Provide to Us?
Broadly speaking, we use personal information for purposes of administering our business activities, providing service and support and making available other products and services to our customers and prospective customers. Occasionally, we may also use the information we collect to notify you about important changes to our website, new services and special offers we think you will find valuable. The lists used to send you product and service offers are developed and managed under our traditional standards designed to safeguard the security and privacy of all personal information provided by our users. You may at any time to notify us of your desire not to receive these offers.
What Are Cookies?
Cookies are a feature of web browser software that allows web servers to recognize the computer used to access a website. Cookies are small pieces of data that are stored by a user's web browser on the user's hard drive. Cookies can remember what information a user accesses on one web page to simplify subsequent interactions with that website by the same user or to use the information to streamline the user's transactions on related web pages. This makes it easier for a user to move from web page to web page and to complete commercial transactions over the Internet. Cookies should make your online experience easier and more personalized.
How Do We Use Information Collected From Cookies?
We use website browser software tools such as cookies and web server logs to gather information about our website users' browsing activities, in order to constantly improve our website and better serve our users. This information assists us to design and arrange our web pages in the most user-friendly manner and to continually improve our website to better meet the needs of our users and prospective users.
Cookies help us collect important business and technical statistics. The information in the cookies lets us trace the paths followed by users to our website as they move from one page to another. Web server logs allow us to count how many people visit our website and evaluate our website's visitor capacity. We do not use these technologies to capture your individual email address or any personally identifying information about you.
Notice of New Services and Changes
Occasionally, we may use the information we collect to notify you about important changes to our website, new services and special offers we think you will find valuable. As a user of our website, you will be given the opportunity to notify us of your desire not to receive these offers by clicking on a response box when you receive such an offer or by sending us an email request.
How Do We Secure Information Transmissions?
When you send confidential personal information to us on our website, a secure server software which we have licensed encrypts all information you input before it is sent to us. The information is scrambled en route and decoded once it reaches our website.
Other email that you may send to us may not be secure unless we advise you that security measures will be in place prior to your transmitting the information. For that reason, we ask that you do not send confidential information such as Social Security, credit card, or account numbers to us through an unsecured email.
How Do We Protect Your Information?
Information Security -- We utilize encryption/security software to safeguard the confidentiality of personal information we collect from unauthorized access or disclosure and accidental loss, alteration or destruction.
Evaluation of Information Protection Practices -- Periodically, our operations and business practices are reviewed for compliance with organization policies and procedures governing the security, confidentiality and quality of our information.
Employee Access, Training and Expectations -- Our organization values, ethical standards, policies and practices are committed to the protection of user information. In general, our business practices limit employee access to confidential information, and limit the use and disclosure of such information to authorized persons, processes and transactions.
How Can You Access and Correct Your Information?
You may request access to all your personally identifiable information that we collect online and maintain in our database by emailing us using the contact form provided to you within the site structure of our website.
Do We Disclose Information to Outside Parties?
What About Legally Compelled Disclosure of Information?
We may disclose information when legally compelled to do so, in other words, when we, in good faith, believe that the law requires it or for the protection of our legal rights.
Permission to Use of Materials
The right to download and store or output the materials in our website is granted for the user's personal use only, and materials may not be reproduced in any edited form. Any other reproduction, transmission, performance, display or editing of these materials by any means mechanical or electronic without our express written permission is strictly prohibited. Users wishing to obtain permission to reprint or reproduce any materials appearing on this site may contact us directly.
We are grateful for your donation and support of our organization. If you have made an error in making your donation or change your mind about contributing to our organization please contact us. Refunds are returned using the original method of payment. If you made your donation by credit card, your refund will be credited to that same credit card.
Automated Recurring Donation Cancellation
Ongoing support is important to enabling projects to continue their work, so we encourage donors to continue to contribute to projects over time. But if you must cancel your recurring donation, please notify us.