ED CARE COORDINATOR - Care Integration - Per Diem - Days

PATIENT POPULATION: The patient population served is all patients, including geriatric, adult, adolescent, pediatric, and newborn. This also includes services which affect facility staff, physicians, visitors, vendors and the general public.

Under the direction of the department leader and clinical oversight by the Vice President of Quality and Regulatory Affairs (LCSW), the ED Care Coordinator uses pre-established guidelines and criteria to perform review activities assuring proper utilization of hospital resources for Medicare, Medi-Cal, HMO’s and other third party payers. Takes appropriate follow up action when established criteria for utilization of services are not met, in order to ensure that denials are avoided.

Identifies medically indigent patients and monitors closely to ensure that appropriate placement is secured; works with patient and family to determine if other sources of funding may be applicable. Maintains appropriate documentation of review performed, according to pre-established criteria, indicating severity of illness and intensity of services rendered with acute/ post-acute hospitalization. Acts as Liaison with physician(s) to: 1) ensure all covered aspects of treatment are fully documented, and (2) assist in identifying other options for care when patient no longer requires acute hospitalization, securing appropriate discharge planning and home health services, and long-term care placement.

Must be able to work normal/scheduled working hours to include Holidays, call-backs, weeknights, weekends, and on-call. Agrees to participate, as directed, in emergencies and community disasters during scheduled and unscheduled hours. As a designated disaster service worker you are required to assist in times of need pursuant to the California Emergency Services Act.

(Gov’t. Code §§ 3100, 3102) Needs to recognize that they have an affirmative duty and responsibility for reporting perceived misconduct, including actual or potential violations of laws, regulations, policies, procedures, or this organization’s standards/code of conduct. The employee shall work well under pressure, meet multiple and sometimes competing deadlines; and the incumbent shall at all times demonstrate cooperative behavior with colleagues and supervisors.

EDUCATION/TRAINING/EXPERIENCE: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the

. Must meet one of the following criteria: Possess a Master's in Social Work or in a healthcare related field; or Have one (1) year of experience performing social services/casework services in an acute care setting and obtain Master's degree in Social Work or healthcare-related field within ninety (90) days of employment. One (1) or more years of experience in an acute care setting and/or discharge planning preferred.

Proficient in reading and interpreting various documents, including safety guidelines, operational procedures, maintenance instructions, and manuals. Capable of preparing routine reports and correspondence as needed. Ability to speak and write in English, with the ability to write clearly, comprehend verbal and written instructions, and follow directions accurately.

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages if required. Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

To perform this job successfully, an individual should have basic computer skills. LICENSURE/CERTIFICATIONS: Certification in Case Management is desirable. LCSW license is preferred.

Must have and maintain Associate Clinical Social Worker (ACSW) or Associate Marriage & Family Therapist (AMFT) certification within 90 days of hire. Tulare County Law and Ethics- Involuntary Treatment and the 5150 training/test to be completed within 90 days of hire.

Regular, punctual attendance and physical presence at the assigned work location and workstation, ready to perform job duties at the scheduled start time. Provides crisis intervention, psychosocial assessments, and comprehensive discharge planning for patients experiencing acute psychiatric distress, addiction, or severe psychosocial vulnerabilities. This role works closely with the medical team to ensure patient safety, facilitate aftercare coordination, and advocate for high-risk populations.

Initiate 5150 involuntary legal holds or complete safety plans as clinically indicated Take responsibility for convening family/staff meetings to discuss end-of-life care or other similar issues. Responds to staff and community concerns for child or dependent adult neglect and abuse. Evaluates each referred patient and takes the indicated action.

Provides comprehensive social work services in the Emergency Department and MCH during the week, as assigned. Utilizes InterQual/MCG criteria for medical necessity and appropriateness of admission/continued stay or assignment to observation status. Takes appropriate action if patient does not meet criteria.

Acts as a resource to other departments in developing greater awareness of InterQual/MCG criteria and interpret requirements of Federal, State, and third party payor guidelines for coverage. Ensures that all affected hospital departments receive timely notification of inappropriate admission and provides administrative determination documentation. Communicate with the patient/family and physicians regarding issues related to financial coverage which may negatively influence post-Acute Care plan, including discussing alternatives and options as available and appropriate.

Demonstrates ability to transmit referral electronically or by phone referral to physician advisor in a timely manner in cases of potential denial of medical necessity for admission or continued stay. Demonstrates ability to prioritize activities according to urgency of potential utilization problems daily; adapts effectively to changing priorities. Completes work assignments on a timely basis and functions effectively with minimal supervision.

Works collaboratively with the patient's healthcare team to manage resources effectively according to patient needs. Initiates or coordinates timely and appropriate referrals for internal and external services. Discharge planning needs are assessed on admission and throughout the hospitalization with the appropriate resources being arranged in a timely manner.

Maintains record of discharge planning on patient record and other required forms to substantiate continued care planning, i.e., placement attempts, requests for services and determinations made. Requests interdisciplinary conferences to solicit input concerning patients with medically complex issues. Documentation reflects compliance with established Hospital policies and procedures.

OTHER FUNCTIONS: Coordinates transfer arrangements and provides information to other facilities and third party payers such as Kaiser, non-contracting HMO’s, etc. NOTE: Every effort has been made to make this job description as complete as possible. However, it is in no way states or implies that these are the only duties you will be required to perform.

The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is a logical assignment to the position.