Inpatient Care Coordinator / Discharge Planning

The Inpatient Care Coordinator / Discharge Planning role is focused on managing and directing the progression of patient care, ensuring effective discharge planning, and promoting evidence-based protocols within the healthcare environment. This position requires substantial experience in inpatient care coordination and a commitment to quality patient outcomes.

Key Responsibilities

• Review patient records to evaluate progress and promote timely and appropriate discharges.
• Monitor the necessity and appropriateness of hospitalization, length of stay, and quality of care.
• Collaborate with medical leadership and clinical teams to ensure effective healthcare services.
• Develop personalized treatment plans based on patient assessments and needs.
• Facilitate utilization review functions and ensure adherence to regulatory requirements.
• Support claims processing and manage communication with payers, including managing denials and appeals.
• Participate in interdisciplinary collaboration to enhance patient care strategies.
• Provide education and guidance on regulations affecting utilization management and coordinated care plans.
• Maintain comprehensive documentation in alignment with utilization management functions.
• Support clinical improvement initiatives through quality reviews and reporting.

Qualifications

• Bachelor’s degree in Nursing is required.
• Active nursing license is required.
• Minimum of 8 years of clinical care or nursing experience, including 3 years in inpatient care coordination or discharge planning.
• Case Management certification by a recognized certifying organization is preferred.

Skills and Knowledge

• Strong understanding of medical records review for medical necessity and insurance reimbursement.
• Familiarity with ICD-9 and CPT coding.
• Knowledge of regulations set by relevant healthcare governing bodies.
• Proficient in medical terminology, anatomy, physiology, and concepts of disease.
• Exceptional communication and organizational skills.

Additional Information

This position does not require supervisory responsibilities. Other duties may be assigned as necessary to meet the dynamic needs of the healthcare environment.