This position will be located in the Spokane area.
Summary / Objective:
This position is responsible for the implementation of post-acute strategies to manage post-acute transitions of care for PSW members. The PAC is responsible for facilitating the post-acute care of beneficiaries in the program to improve health outcomes, reduce readmissions, manage appropriate length of stay, and reduce barriers to successful discharge.
Essential Functions:
- Support patient monitoring within the post-acute facility to determine appropriate length of stay and coordination of care needs.
- Communication with post-acute facility staff on patient status and monitor census.
- Participate with post-acute interdisciplinary team through routine engagement with preferred network telephonically or in person a minimum of weekly.
- Provide recommendations on next site of care, as needed and/or available.
- Coordinate transitions between skilled nursing facilities and home health agencies; communicating with agency staff on patient status.
- Support discharge to home process including: identify and stratify case management candidates, and coordinate transition from post-acute facility to home.
- Ensure participants have an appropriate follow-up appointment with seven (7) days of discharge from a post-acute facility.
- Refers member to PSW Care Management services as appropriate
- Collaborate with PSW Care Management team and partners on developing workflows, training and communication protocols.
- Follows professional guidelines and uses technology and electronic records for all required documentation.
- Works with team members to improve quality outcomes related to advanced payment model criteria.
- Ensures compliance with CMS and PSW policies and procedures with special emphasis on compliance with HIPAA requirements.
- Meet and exceed all internal audit requests to ensure HIPAA and other compliance requirements are met.
- General clerical duties required.
Required Education and/or Work Experience:
-
2-4 years’ experience working in post-acute settings
- Social Services, Care Coordinator or Care Navigation background
- Excellent computer skills, including proficiency in MS Word and Excel
- Proficiency in typing, grammar, data entry, office machines, basic math and general office procedures
- Proficient with standard office equipment, i.e., multi-line phone, fax, copier, etc.
- Excellent verbal and written communication skills, including ability to effectively communicate with internal and external customers.
Required Certificates, Licenses and Registrations:
- Valid driver’s license and insurance in state of residence.
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Flexible Spending Account (FSA)
- Health Savings Account (HSA)
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance