Essential Job Functions

Weight

Essential Job Function #1:

30

%

• Coordinates written/verbal communication relating to the medical treatment plan (patient/family/physician/other care team members) and communicates the treatment plan to external agencies, as needed, in order to establish and maintain the authorization for precertification and/or continued stay.
• Uses daily worklist to review: payer source (plan type, benefit phone number, p/c phone number, case manager/review agency to be contacted & p/c number), patient information, physician information from hospital systems (daily labs, x-rays, orders, etc.).
• Prioritizes cases according to financial reimbursement and clinical criteria.
• Assessed the medical record to ensure the admission status per registration and physician order coincides with the appropriate level of care.
• Reviews the medical documentation to assist the physicians in obtaining complete and accurate documentation of their medical treatment plan

Essential Job Function #2: Financial Management

30.0

%

• Obtains timely pre-certification of all commercial cases admitted after normal business hours in collaboration with the Access/Intake office staff.
• Notifies the financial counselor of those cases where verification of insurance is questionable. Inform the attending/primary care physician, the Appeal nurse and the PFS department of changes in financial status and days denied by insurance providers.
• Performs concurrent review and provides timely clinical updates to insurance providers.
• Documents days approved by insurance providers, days denied and reason for denial, avoidable days and special discharge needs/plans into hospital/department information system(s) on a daily basis.
  

Essential Job Function #3: Resource Consumption

30

%

• Identifies resource consumption patterns and suggest alternatives to meet patients' needs to the attending or other members of the healthcare team.
• Provides feedback to physicians regarding practice pattern issues and documentation to substantiate (IS/SI) severity of illness.
• Follows best practice examples in order to ensure positive clinical as well as financial outcomes.
• Screens patients at intake such that appropriate level of care is determined initially.
• Obtains appropriate documentation and data to support patients registered status.
• Documents resource issues within the department information system for trending.
  

Essential Job Function #4: Discharge Planning

10

%

• Interacts daily with the Nursing-unit Pt. Care Coordinator and the Clinical Coordinator-Social Workers and when needed the physician, patient/family and other healthcare team members to formulate a discharge plan pertinent to the patient's physical, psycho-social, and financial parameters.
• Facilitates the patient's discharge plan while utilizing opportunities to maximize cost-effective, quality care; decrease length of stay (LOS) and resource consumption.
• Interacts daily with all health team disciplines involved in the patient's care either directly or through the Nursing-unit Pt. Care Coordinator in order to identify issues or obstacles in progress toward treatment plan goals and facilitates problem solving and revision of discharge plan if necessary.
• Manages cases on a daily basis to avoid denials and documents reasons for denials and avoidable days in hospital information system.
• Sets up doc-to-docs and provide pertinent information to appeal any denials and refers cases for appeal and assist with history of case.
• Maintains a working knowledge of electronic discharge program and utilizes it for documentation of discharge arrangements.