JOB PURPOSE OR MISSION

The Post-Acute Coordinator (PAC) is responsible for facilitating, implementing, and confirming post-acute transition plans for the patient population. The position will respond to community-based service requests from any of the patient’s interdisciplinary healthcare team. Support and assist with clerical duties as needed within the department. Performs all job duties for the age population served, as defined in the department’s scope of service.

ESSENTIAL JOB FUNCTIONS include, but are not limited to:

1. Transition Preparations

• Advocate for the patient by expediting post-acute placement and/or discharge logistics.
• Confirm receipt of electronic referral for discharge logistics (DME, home health, hospice, transportation, post-acute placement, etc.)
• Obtains and processes activities that prepare for post-acute transition such as completing necessary forms, reports, patient signatures, and requisitions as needed.
• Partner with the interdisciplinary team to implement post-acute placement for SNF, rehab, sub-acute, assisted living facility or other discharge logistics as ordered.
• Confirm patients’ benefits, identify preferred providers, and uses knowledge of community availability to effect timely disposition.
• Confer with care coordinators to prioritize discharge requests.
• Complete and transmit necessary forms to facilitate placement of patient.
• Use electronic software to distribute post-acute placement requests to regional resources and identifies availability.
• Establish and maintain routine communication with referring interdisciplinary team to keep them informed of the progress of their request.
• Identify any obstacles to timely transition and collaborates with the care coordinator to resolve the issue. Record avoidable days in the electronic software as it applies.
• Document placement in the electronic software as it applies.
• In collaboration with requesting clinician, arrange safe transportation that best fits the patient’s needs and financial resources.
• Update all involved parties regarding progress, revisions and other information related to implementing the plan.
• Maintain log of any quality issues encountered with preferred providers that require follow-up.

2. Community Based Services

• Facilitate prompt processing of all requests for post-acute services including durable medical equipment (DME), or appointments with community resources.
• Collaborate with the patient and interdisciplinary team to coordinate follow-up appointments for patients with their primary care physician and/or specialist provider.
• Document appropriate referrals and/or appointments in the electronic medical record prior to discharge.
• Resolve any pre-certification, registration, or form completion prior to setting up an appointment with a community provider.
• Participate in follow-up processes to discharged patients to query about quality and timeliness of post-acute arrangements.
• Demonstrate independent problem-solving skills on behalf of the case management team and the patient.
• Professionally respond to payer’s request for information.

3. Utilization Review and Departmental Support Activities

• Review in-house observation patients and provide the Medicare Outpatient Observation Notice (MOON). Document completion in the electronic software as it applies.
• Review anticipated discharges and provide appropriate Medicare patients with the Important Message from Medicare (IMM) follow-up notice. Document completion in the electronic software as it applies.
• Escalate any patient questions regarding the MOON and/or IMM timely to the care coordinator and/or utilization review nurse.
• Support and assist with clerical duties as needed within the department by:
  • Receiving and relaying messages to/from the care management team to other areas in the hospital and community and providing information whenever possible to reduce interruptions.
  • Recording and transcribing meeting meetings as requested.
  • Using the appropriate outlet (electronic software, fax, email, photocopy, text, and/or phones) to securely transmit information to agencies.

4. Performance Improvement Activities

• Report sentinel events and quality of care issues to the department leadership team.
• Collect and track data as determined.
• Participate in performance improvement activities as indicated.
• Articulate the organization and program mission and goals.
• Demonstrate the ability to effectively manage time.
• Attend and participate in daily huddles and monthly departmental meetings.
• Demonstrate knowledge of and adhere to all organization and department policies and/or procedures.
• Promote program stability, reputation, and growth by coordinating positive teamwork with colleagues.
• Appropriately receive constructive guidance from senior staff and/or leadership.
• Preserve the basic human rights of expression, decision, action, confidentiality and personal dignity for all patients and families.
• Respect the cultural diversity of all patients, families, and employees.
• Demonstrate effective team building activities.
• Demonstrates mature negotiation and conflict management strategies and skills.
• Demonstrates effective use of critical thinking skills to independently solve problems.
• Demonstrate knowledge of current regulatory and accrediting agency requirements as it pertains to obtaining services for patients.
• Demonstrates a curiosity about the healthcare industry and its potential impact on hospitals in general, and the case management department.

5. Performs all other duties as assigned.

HIPAA & SAFETY REQUIREMENTS

HIPAA - Maintains knowledge of and adherence to all applicable HIPAA regulations appropriate to the job position, including but not limited to: Medical records without limitation of both paper and electronic, patient demographics, lab and radiology results, patient information related to surgery or appointment schedules, information related to patient location, religious beliefs and/or public health records, medical records related to quality/data, patient financial information and/or 3rd party billing, patient-related complaints, research information, employee health records and employee prescriptions.

Safety - Maintains knowledge of and adherence to all applicable safety practices appropriate to the job position, including but not limited to: Incident reporting, PPE, exposure control plans, hand washing, environment of care, patient identification.

PERFORMANCE CRITERIA

Everyday Excellence Values – Employee demonstrates Everyday Excellence values in the day-to-day performance of the job.

• Demonstrates courtesy and caring to each other, patients and their families, physicians, and the community.
• Takes initiative in living our Everyday Excellence values and vital signs.
• Takes initiative in identifying customer needs before the customer asks.
• Participates in teamwork willingly and with enthusiasm.
• Demonstrates respect for the dignity and privacy needs of customers through personal action and attention to the environment of care.
• Keeps customers informed, answers customer questions and anticipates information needs of customers.

Corporate Compliance – Employee demonstrates commitment to the Code of Conduct, Conflict of Interest Guidelines, and the GHS Corporate Compliance Guidelines.

• Practice’s diligence in fulfilling the regulatory and legal requirements of the position and department.
• Maintains accurate and reliable patient/organizational records.
• Maintains professional relationships with appropriate officials; communicates honestly and completely; behaves in a fair and nondiscriminatory manner in all professional contacts.

Personal Achievement – Employee demonstrates initiative in achieving work goals and meeting personal objectives.

• Uses accepted procedures and practices to complete assignments. Uses creative and proactive solutions to achieve objectives even when workload and demands are high.
• Adheres to high moral principles of honesty, loyalty, sincerity, and fairness.
• Upholds the ethical standards of the organization.

Performance Improvement – Employee actively participates in Performance Improvement activities quality improvement standards in his/her job performance.

• Optimizes talents, skills, and abilities in achieving excellence in meeting and exceeding customer expectations.
• Initiates or redesigns to continuously improve work processes.
• Contributes ideas and suggestions to improve approaches to work processes.
• Willingly participates in organization and/or department quality initiatives.

Cost Management – Employee demonstrates effective cost management practices.

• Effectively manages time and resources.
• Makes conscious effort to effectively utilize the resources of the organization – material, human, and financial.
• Consistently looks for and uses resources saving processes.

Patient & Employee Safety – Employee actively participates in and demonstrates effective patient and employee safety practices.

• Employee effectively communicates, demonstrates, coordinates and emphasizes patient and employee safety.
• Employee proactively reports errors, potential errors, injuries or potential injuries.
• Employee demonstrates departmental specific patient and employee safety standards at all times.
• Employee demonstrates the use of proper safety techniques, equipment and devices and follows safety policies, procedures, and plans.

JOB REQUIREMENTS

Experience

Required - Hospital experience with basic knowledge of medical terminology or clinical experience

Education

Required - High School Diploma or Associate degree (Equivalent work experience supporting professional staff activities may be substituted).

License & Certification

Required - none

Special Skills & Knowledge

Required - Ability to prioritize tasks

Preferred - Strong computer knowledge with effective interpersonal communication skills