Title: RN, Coord, Clinical Admissions
Location: Long Beach, CA
Department: Cap Utilization Management
Status: Full Time
Shift: Day
Pay Range: $53.18/hr – $73.57/hr
At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in Healthcare. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.
Position Summary
The clinical admissions coordinator is a licensed professional who facilitates the process of patient admissions to ensure the appropriate, timely, and smooth transition of patients into Long Beach Memorial Medical Center. The clinical admissions coordinator collaborates with the patient/family, members of the health care team, physicians, and payors to assure that patients meet the established criteria and are admitted to the appropriate level of care to meet the patient’s needs. The clinical admissions coordinator, upon request, is also responsible for the investigation and administration of Affordable Cash Elective Admissions and discounts/waivers based on financial and other hardships.
Essential Functions and Responsibilities of the Job
Admission Coordination
The clinical admissions coordinator screens elective, direct, and transfer-in admissions utilizing established criteria for admission and patient placement, through direct and continuous interaction with the Admitting Representative handling same-day admissions intake and financial screening. The information provided via the Pre-Admission Evaluation form is used by the clinical admissions coordinator to assure Long Beach Memorial Medical Center has the capacity to care for the patient and to facilitate placement of patients at the level most appropriate for their care needs while maintaining compliance with federal regulatory agencies as it relates to intake and record keeping requirements. The clinical admission coordinator has heightened involvement in any and all difficulties with the patient placement and transfer-in admissions process including, but not limited to, delay in bed availability, over flow decision making, inadequate information available for patient acceptance and appropriateness of transfer and/or intake.
Continuum of Care / Quality
The clinical admissions coordinator provides leadership in problem solving with the Admitting Department, Patient Care Services, and physicians when the information gathered via the Pre-Admission Evaluation does not meet established criteria and/or the Patient Placement Guidelines for the level of care requested by the physician. The clinical admissions coordinator assists physicians as needed in identifying and arranging alternatives to inpatient admission. The clinical admission coordinator always acknowledges the physician’s ultimate authority for admission, level of care, and admission alternative decision making.
The clinical admissions coordinator is responsible for assessment of patients presenting to the Admitting Department, either upon arrival or via information gathered on the Pre-Admission Evaluation form, to determine if the patient’s condition and/or diagnosis warrants immediate referral to the Emergency Department for a medical screening exam. The clinical admissions coordinator assures the safe disposition of patients assessed to require an immediate screening exam in collaboration with the physician and the Emergency Department.
The clinical admissions coordinator communicates with the Admitting Department, Patient Care Services, and medical staff on quality issues by various means, including but not limited to, completion of the Problem Admission/Transfer form and referral to the Combined Resource Management Committee.
Utilization Management
The clinical admissions coordinator works collaboratively and proactively with patients, physicians, and payors in managing patient resources. The clinical admissions coordinator incorporates knowledge of medical necessity, established criteria, and MAPs to evaluate appropriateness of admissions. The clinical admissions coordinator uses the appropriate system to provide documentation and to analyze charges vs. reimbursement and contract information so that all constituents are informed of the financial impact of the admission. The clinical admissions coordinator will provide clinical information, in collaboration with the physician, to payors to facilitate the authorization process.
The clinical admissions coordinator is responsible for the research and administration for Affordable Cash Elective Admissions, ensuring that patients are well informed of the cost of the care they have elected to receive. The clinical admissions coordinator investigates and processes requests for discounts and waivers based on financial hardship and other extenuating circumstances according to hospital policy.
Minimum Requirements:
- This position requires strong verbal and written communication skills with the ability to communicate well with people from diverse socioeconomic backgrounds.
- The case manager is knowledgeable of criteria for medical necessity for each level of care through the continuum of care.
- A knowledge of reimbursement related to MediCare, MediCal, Capitation, and Managed Care is required.
- Three years’ experience in clinical field of expertise with two years’ experience in an acute setting is preferred.
Education/Licensure/Certification:
- Current California License in field of expertise.
- Bachelors degree in health related field.
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