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Human Resources: 700 Lawn Avenue, Sellersville, PA 18960  |  215-453-4874
Patient Care Coordinator, RN
Full Time, 8:30am-5pm, Monday-Friday
Sellersville, PA 18960

There's a new era of wellness ahead, and we no longer think about treating our bodies only when we're sick but nurturing our bodies when we are well, so we can stay in a perpetual state of good health. Grand View Health is leading the way to this new era with investments in technology, facilities, partnerships and, most importantly, compassionate and exceptional talent. Located in Upper Bucks County, Pennsylvania, Grand View Health is a well-established, independent hospital offering a full range of healthcare services. Our colleagues enjoy the best of both worlds by working for a high-quality, low-cost healthcare provider in a collaborative, community environment. Help us build this new era of wellness.
 

Responsibilities

The Patient Care Coordinator is responsible for the overall coordination of care for an assigned caseload. Concurrent and retrospective clinical review of inpatient medical records to evaluate the utilization of acute care services. Specific reviews are determined both internally and by requirements/requests of external payers or regulatory agencies, and play a significant role in obtaining reimbursement for acute care services. Goal is to collaborate with patients, families and healthcare providers to promote health and manage illness. Facilitates the use of assessment, coordination and education to achieve quality patient care outcomes while coordinating interdisciplinary comprehensive and cost-effective care across the continuum.

This is a full time position. The hours are Monday–Friday, 8:30am-5:00pm.

Job duties include, but are not limited to:
  • Performing 100% admission review on first working day after admission utilizing InterQual criteria.
  • Conducting admission and continued stay reviews utilizing the appropriate severity of illness/intensity of service criteria and pertinent nursing knowledge.
  • Effective management of patient status related to billing, compliance and registration.
  • Effectively using case management software to manage the denial process and reasons.
  • Communicating denials from third-party payers to the physician, Case Management support staff and manager to ensure timely appeal process.
  • Serving as a resource to patients, physicians and their personnel, administration and hospital employees regarding issues related to the appropriateness of inpatient care and reimbursement.
  • Proactively preventing denials and delays in patient care provision.
  • Interviewing patient/family to assess discharge planning needs and providing insurance education 24 hours after admission notification to ensure a safe discharge. Arranging for community services prior to discharge to meet patient's post-discharge needs with recognition and documentation of patient choice of service providers.
  • Performing discharge screening within one working day of admission and, when appropriate, referring patients who may require intensive discharge planning.
  • Advocating for the patient/family with other healthcare professionals and community agencies as indicated to enable them to negotiate various social systems.
  • Working collaboratively with other healthcare disciplines (P.T., R.T., dietary, nursing, physicians), utilizing the expertise of all in a team effort to facilitate discharge planning and meet patient/family needs.
     

Qualifications

  • RN degree and license required.
  • Over 3-5 years of acute care experience.
  • 2 years of acute care case management.
Grand View Health is an equal opportunity employer.
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"At Grand View, you are more than just a number. You are a person… a professional with a voice."
Heather M., Physical Therapist
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