Care Team Coordinator (Psciii)

Massachusetts General Hospital Boston , MA 02298

Posted 2 months ago

The Care Team Coordinator is an essential part of the care team serving as the primary point of contact for patients. The Patient Services Coordinator/Care Team Coordinator (CTC), under general supervision, provides administrative support to healthcare providers in a high-volume ambulatory practice setting. The CTC: Care Team Coordinator works with the Physician Assistant to provide Urologists with the necessary support for their practices. Primary responsibility includes working with Physicians on visit planning for scheduled patients, maintaining calendars, communicating changes in schedules, and assisting with academia and research for respective physicians. Our care teams will "partner" with each patient to define and reach their customized health goals. These health goals will be achieved by providing the patient with superior access to care, information and tools that promote collaboration with their care team and increased self-management of health. The design of the care teams, clinical operations, space and technology will ensure that each staff member is well supported and can effectively use their unique skills as they collaborate to care for patients.

Essential Responsibilities

The CTC will serve as the key interface between the Urology care team and the patient. The CTC will support care team members in all matters related to care coordination and management and will simultaneously serve as a proactive and ready resource for all care coordination needs and inquiries by patients. More specifically:

1.Within the patient visit or other patient interactive processes, the CTC will support the patient and care team in arranging for and coordinating needed patient care services, including but not limited to the following activities:

  • Scheduling visits with specialty consultants or other specialized providers of medical care and research trials.

  • Arranging for tests and other procedures needed by patients.

  • Processing/requesting any necessary insurance referrals or prior approvals related to above services.

  • Documenting and monitoring all required services, and their ultimate completion status, within the "Care Coordination" tracking system. At completion of services, tracking and notification to care team of "urgent care" items.

  • Ongoing and proactive communication with patients and their care team members regarding completed scheduling of services or issues encountered in the care coordination effort.

  • Monitoring of clinical activities to be completed by the patient, including routine screening tests, laboratory, consultant visits, virtual monitoring in the home, return visits to the practice, etc.

  • In regard to vi. above, proactive outreach to patients that are not in compliance with planned care efforts and/or expected timing of such efforts. Related, communication to appropriate care team members when difficulties encountered in securing patient compliance with planned care efforts.

  • Interface with specialty/testing office staff or providers to facilitate urgent or expedited care needs of practice patients, to secure feedback on care provided and care plans, etc.

  • Obtaining pre-visit requirements: orders, outside films, pathology reports, slides, x-rays, x-ray report and lab results, as well as any addition clinical information needed to insure efficiency and accuracy of consultations and second opinions visits.

  • Checking care team schedules in advance to patient's arrivals. While preparing charts. Send out confirmation/reminder letters in advance of appointments

  • With regard to assisting in the successful management and execution of the Urological Care, the CC will:

  • Answering and screens telephone calls coming in from Access Team members and/or patients. Takes accurate message or directs call to appropriate person. Greets and directs patients, families, visitors and staff. Responds to the requests in a timely manner and provides clear, accurate information within scope of knowledge and authority.

  • Document in the electronic medical record, as appropriate, coordination efforts as they pertain to the goals within care team.

  • Monitor patients' demographics and insurance information as necessary and obtain specialist referrals for all patient's appointments. Schedules patient appointments utilizing scheduling tools and resources. Coordinates and communicated ancillary appointments and procedures working with other hospital staff as needed.

  • Assess continuing needs to achieve documented health goals, in collaboration with the care team, and work to address them.

  • Identify key barriers to care and patient's ability to manage their health and wellness.

  • Facilitate access to necessary services by navigating any barriers to care and advocating on the patient's behalf.

  • Act as the liaison by consulting and collaborating with members of the health care team, including the APF care team and outside providers caring for the patient in order to promote continuity of care and attainment of health and wellness goals.

  • Promote wellness and empower the patient to take an active role in the management of their own health.

  • The CTC will maintain the physician's administrative and clinical calendars. Types correspondence, manuscripts, and documents that may require complex formatting. Composes routine correspondence. Transcribes letters and patient notes as needed for physicians and/or facilitates notes and letter in Epic System. Composes routine correspondence. Prepares and distributes material for meeting and committees.

  • The CC will manage preparation for surgical cases, confirm pre-op testing, compile necessary paperwork, and confirm date and time of procedure with patients.
    5.The CC will actively participate in daily team huddles and care team meetings to update team members on the care coordination efforts and status thereof, for any patient requiring or requesting services.

6.In a combined effort with the Care Team, the CC will support care triage as follows:

  • With "high touch - high service" attitude and expertise, effectively manage incoming care need communications from patients and families, whether by phone, care team staff messages or the Patient site In this effort, work effectively to fully investigate, understand and document the patient's needs, concerns and expectations for response, and then communicate back to patients your understanding of patient needs and response expectations, and your next steps toward providing the needed care.

  • With a complete understanding and documentation of patient needs, interface with the patient's team (medical secretary, nurse, APP, MD) to direct messages to those team members that are most appropriate for timely evaluation and response to patient needs. Whenever possible, be proactive in closing the loop with the patient and in supporting the team in whatever way possible.

  • Assist patients with:

  • Completion of practice appointment scheduling

  • Insurance referral processing or questions, referring them to appropriate department

  • Informing practitioners of medication refills

  • Questions regarding lab or other test results

  • Insurance and billing questions

  • Medical forms and record requests

  • Use of technologies created for patient use, i.e. personal health web-site, etc.

  • All other administrative matters

Follows all scheduling guidelines as defined by MGH Urology management

  • High School diploma required

  • Some college or Associate's Degree preferred

  • 1-2 years of secretarial, customer service experience or equivalent in a medical or healthcare-related setting

  • Preferred: Experience in a clinic, medical or healthcare related setting

  • Knowledge of computer skills necessary to use programs required for day to day clinic operations (Word, Excel, Outlook, internet, MGH electronic health systems, etc)

  • Good verbal and written communication, including the use of medical terminology

  • Exceptional organizational skills, flexibility to manage multiple tasks and the accurate attentive to details

  • Ability to work independently or within a team environment

  • Excellent and effective interpersonal and communication skills

  • Excellent customer service skills

  • Demonstrated ability to work effectively and courteously with various groups of patients, staff and providers.

  • Demonstrated ability to problem solve and function as a resource to other members of the team, and resolve complex issues on behalf of the providers and the patients.

  • Demonstrated in-depth understanding of managed care and all other pertinent insurance/medical coverage

  • Demonstrated knowledge of HIPAA Confidentiality and Privacy Policies

  • Demonstrated understanding of Disaster protocols to include: fire, safety and code calls, per the mandatory training, as outlined by MGH and JCAHO guidelines

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
RN Care Coordinator (Case Manager) / 40 Hours / Variable Rotating BWH Care Coordination

Brigham And Women's Hospital

Posted 7 days ago

VIEW JOBS 11/19/2020 12:00:00 AM 2021-02-17T00:00 GENERAL SUMMARY/ OVERVIEW STATEMENT: Position Summary The RN Care Coordinator (RNCC) manages a caseload of patients and is responsible for ensuring care that supports desired clinical and financial outcomes. Has the skills and knowledge specific to the unique needs of assigned patients. Coordinating the care prescribed by an interdisciplinary team, the RNCC utilizes patient assessment, care guidelines, protocols, payer regulations and response to therapies to assess the episode of illness from pre admission to post discharge. Participates in the ongoing evaluation of practice patterns and systems and supports efforts to improve quality, cost and satisfaction outcomes. Mobilizes resources to maximize efficiency of care delivery. PRINCIPAL DUTIES AND RESPONSIBILITIES: Principle Responsibilities A. Care Facilitation Coordinates and insures implementation of the plan of care, utilizing case management principles. * Prior to or within 24-48 hours of admission the RNCC, by interview of the patient/family, discussion with physician team and/or attending MD and other team members, develops a provisional treatment program and tentative discharge date. * Reviews daily treatment plan with physicians, nurses and patient / families to insure interdisciplinary communication and coordination is occurring. * Participates with nursing staff and physicians in patient care rounds to contribute to plan of care and monitor and report patient progress. * Collaborates with other departments to expedite sequencing and scheduling of interventions, consults, treatments and ancillary services. * Provides for daily continuity with patients to assure patient needs related to discharge are met. * Incorporates knowledge of utilization management principles and payer contracts into patient plans of care. Keeps physicians and nurses informed of implications. * Presents alternatives to inpatient stay to attending MD, team and patient / family based on assessed patient level of care and insurance benefits. * Seeks assistance and/or consultation from Care Coordination leadership with plans for outlier and potential or actual resource intensive patients. * Interacts with internal and external health care providers to facilitate patient care including post discharge services. * Contributes to the development, implementation and monitoring of practice guidelines. * Identifies attending, resident and nurse learning needs related to case management and works with service leaders to develop educational plan. B. Discharge Planning Coordinates and executes the discharge planning process for patients, ensuring each patient has a discharge plan. * Assesses continuing care needs in conjunction with other caregivers. * Coordinates and schedules interdisciplinary meetings with the patient and family regarding discharge needs and plan as appropriate. * Assures patient education consistent with discharge plan has occurred. * Identifies service, treatment and funding options for post-hospital care. * Promotes interdisciplinary patient/family communications and documentation that facilitate discharge planning striving to finalize plans the day prior to discharge. * Performs patient/family follow-up after discharge to monitor and support desired outcomes. * Initiates contact with home health agencies and extended care facilities to insure prompt and effective transition of care. C. Utilization Management Collaborates with appropriate individuals, departments, and payers to insure appropriateness of admission, continued days of stay, and reimbursement. * Identifies patients who are likely to have unmet insurance and resource needs and communicates with and/or makes referrals to other members of the health care team and other appropriate departments. * Communicates as needed with third party payers regarding patient's progress with treatment plan. * Identifies need for and issues Medicare notices of non-coverage, providing appropriate documentation of the process and communication to patient/family and other members of the health care team. QUALIFICATIONS: * Education: Graduate of an approved school of nursing with current registration in Massachusetts. Bachelor of Science Degree in Nursing is required. * Knowledge and skills to differentiate levels of care required. * Five years of previous acute care experience in related clinical specialty preferred. * Two or more years' experience with hospital utilization review and medical criteria sets preferred. * Five years of experience with discharge planning, knowledge of community resources and patient education principles preferred as a case manager. * Certification in case management preferred. SKILLS/ ABILITIES/ COMPETENCIES REQUIRED: * Previous experience in a hospital or health care setting. * Bilingual (English/Spanish) preferred. * Strong clinical assessment skills. * Excellent interpersonal skills including ability to work collaboratively and cooperatively within a team and with internal and external customers. * Strong organizational skill and ability to set priorities. * Ability to compile data from concurrent and retrospective medical record review to determine clinical appropriateness, able to demonstrate the ability to meet a patient's needs based on their clinical diagnosis, level of care and discharge plan. * Ability to negotiate several aspects of care coordination simultaneously. * Excellent written and verbal communication skills. WORKING CONDITIONS: Works in a busy and at times stressful hospital and office environment. Must be flexible and able to work well independently. Brigham And Women's Hospital Boston MA

Care Team Coordinator (Psciii)

Massachusetts General Hospital