Managed Care Company seeking Patient Care Coordinator 

OPPORTUNITY TO WORK FROM HOME AFTER 6 MONTHS

Responsibilities include, but are not limited to the following:                

• Review and evaluate all requests for elective inpatient admission.
• Authorizes those inpatient requests that meet the health plan's approved UM criteria.
• Conduct initial inpatient review and determine the appropriateness of admission, anticipated length of stay and potential discharge needs.
• Document the inpatient review in the computer system.
• Perform concurrent review and enter information in the computer system in a timely manner.
• Assess and coordinate referrals for inter-hospital transfers and specialty care.
• Appropriately and expeditiously refer cases to the Medical Director.
• Generate Approval and Denial letters based on Medical Director's determination.
• Alert providers of denials.
• Refer cases to re-insurer in a timely manner
• Actively participate in Clinical Rounds.
• Actively participate in the discharge planning process with the facility discharge planner to ensure timely discharge, appropriate follow up and continuity of care.
• Facilitate requests for Sub-Acute care, DME, Home Health Care and Transportation.
• Refer cases with quality of care concerns to the Medical Director and Quality Improvement Dept.

Requirements:

• Registered Nurse in New York State required
• Associates Degree in Nursing, or Diploma in Nursing with at least 10 years of Nursing  
• At least five years experience as a Registered Nurse in an adult acute care setting (ER, Critical Care, Med/Surg) required 
• Experience in Managed Care organization required
• Experience in Home Health, Community Health/Outreach and Discharge Planning is helpful 
• Must have the ability to communicate effectively in English; a second language is preferred

Please send resumes to estoler@greenkeyllc.com and visit us at www.greenkeyhc.com