Care Facilitator- Per Diem- Canton-Potsdam Hospital

SUMMARY: Comprehensively plans with the health care team to ensure patient needs are met and care delivery is coordinated across the continuum. Identifies and works to eliminate/minimize system variation and service delivery barriers that prevent achievement of optimal patient outcomes in the expected time frame and with most efficient utilization of resources. Carries out activities related to utilization management, discharge planning, care coordination and referral to other levels of care. Performs as an integral part of the interdisciplinary team promoting interdisciplinary collaboration and champions service excellence. Facilitates assignment of level of care, considers payer requirements and responds accordingly to avoid adverse financial consequence to patient and hospital. Provide superior customer service by modeling the Brand Promise and Core Values.

RESPONSIBILITIES:

• Conducts clinical reviews utilizing objective criteria (Interqual) to assign patient to the appropriate level of care; identifies clinical resources required to achieve optimal patient outcomes and appropriate reimbursement for the hospital.

• Documents level of care and medical necessity in the Care Management Data base to support the clinical review process.

• Concurrently monitors resources utilization, performing continued stay reviews and assists with managing the length of stay of patients across the continuum.

• Appropriately identifies and refers cases to the Review Physician Advisor to validate level of care based on medical necessity to support timely progress of patient along the continuum.

• Functions as a resource to health care team for payor requirements, ensuring optimal use of patient health care benefits.

• Fosters relationships with payors and facilitates communication between hospital and payor as appropriate.

• Concurrently communicates clinical information to payors; severity of illness, intensity of service and plan of care.

• Performs retrospective reviews on insurance denials and assists in appeal process.

• Participates in daily Huddles, providing ongoing communication to the Charge Nurse and Nurse Manager to address complex clinical issues, system barriers, and patient/family issues, concerns.

• Works with Care Management Leadership to identify problems, recommend solutions and work toward resolution.

• Utilizes data, trends and reports to proactively identify opportunities to improve processes and practice.

REQUIRED QUALIFICATIONS:
Required Degree

• Associates degree from an accredited School of Nursing required

Required Certification/Licensure

• Licensed in New York State as a Registered Nurse

Required Years of Experience

• For hires after 10/28/2024, 3 years acute hospital care experience required. If, hired prior to 10/28/2024, 3 years acute hospital care experience not required.

PREFERRED QUALIFICATIONS:

• Case Management or Utilization Management experience preferred.

• Bachelor’s Degree preferred