The Care Coordinator II has shared responsibility for optimizing the use of and reimbursement for hospital inpatient services by participating in the implementation of the hospital’s Utilization Management Plan. As directed, this individual will participate in the managed care process, including managed Maine Care (APS), and in the development and documentation of the patient’s transition/discharge pan. These duties are designed to support the hospital’s mission in the pursuit of excellence in care/service.
The areas of focus include assisting/conducting admission and continued stay record reviews utilizing approved criteria and querying teams regarding medical necessary and active treatment. The Care Coordinator II will work with the clinical team to articulate and document the discharge plan, updating it as needed and coordinating the discharge planning process. With supervision, this individual will act as a liaison with third party payers/managed care companies. This individual will also apply quality screens to medical records and participate in other data collection activities.
The Care Coordinator II will support the hospital’s Performance Improvement Plan by actively participating in multidisciplinary performance improvement teams. This individual will contribute to the ongoing continuing education programs and effectively communicate with all customers, both internal and external.
Required Minimum Knowledge, Skills, and Abilities (KSAs)
Education: Bachelor’s degree in Nursing, Social Work or related field required. Master’s degree preferred.
Experience:5+ years of relevant experience may be considered in substitution. Experience in healthcare required. Psychiatric setting preferred.
MaineHealth is a health system whose members and affiliates include hospitals, physician practices, long-term care facilities, home care agencies, and support services. Learn more about this system at www.mainehealth.org