Resp & Qualifications
PURPOSE: The Onsite/Dedicated Hospital Transitions Coordinator (HTC) is assigned to a specific hospital or facility (Inova Fairfax Medical Campus) within their Region to which they are familiar and oversees the Total Cost and Care Improvement (TCCI) Program, as follows:
1. Supports the TCCI Program for all hospitalized CareFirst members, ensures the coordination and continuity of health care as patients transfer between different locations or levels of care
2. Accountable for improving coordination between patients, providers and caregivers through communication and follow up
3. Provides rapid triage to the appropriate Care Management Programs, including Complex Care Management through the Primary Care Medical Home (PCMH), Wellness, Disease Management, Home Based Services, and Comprehensive Medication Review to best address ongoing health needs of the member.
4. Ensure Members have a Primary Care Provider (PCP) and are scheduled for a post-discharge appointment before the Member is discharged from the hospital.
5. Conduct a clinical assessment of the Member and determine if the Member has ongoing care needs. Document findings as the Assessment Outcome.
6. Performs concurrent review for CareFirst members in accordance with the length stay guidelines outlined for the TCCI Program.
7. Consults with the Medical Director for medical necessity determinations and appropriateness of care.
PRINCIPAL ACCOUNTABILITIES: Under the general direction of the Director of Regional Care, the incumbent’s accountabilities include, but are not limited to, the following:
Rapidly triages members into the appropriate levels for the TCCI program.
Implements an effective TCCI program for members identified as Level 1.
Communicates and interacts professionally with physicians, other providers, and members.
SUPERVISORY RESPONSIBILITY: Oversees the hospital discharge planning process and coordinates the discharge plan with multiple healthcare professionals.
Requires a bachelor’s degree in Nursing or equivalent experience and must have 7-10 years of increasingly responsible hospital related experience working in Care Management, Discharge Coordination, Home Health, or Disease Management; must possess extensive knowledge of how to manage care delivery guidelines and systems. Proven care management experience is critical.
The incumbent must have excellent analytical and problem solving skills, excellent organizational, communication and coordination skills. The incumbent must have effective presentation, negotiation and influencing skills to interface with all levels of management and physician practices. The incumbent must be able to apply complex problem solving abilities to achieve problem and process solutions.
The incumbent is required to have had the vaccinations listed below and been appropriately screened (and cleared) for the items listed below. If the incumbent has not had them or been screened and cleared, they must do so upon acceptance of offer:
The incumbent is required to complete the following training as assigned by Management, including, but not limited to:
** Onsite Hospital Assignments are subject to change based on evolving business needs
A current DC, MD, or VA Registered Nurse License is required.
Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
MSN or CCM, and familiarity with web based software application environment
Department: Hospital Transition of Care
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 12/20/2018
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
Potential Job Hazards:
The position is located within an inpatient hospital facility.
There is the potential for exposure to airborne illnesses, such as, but not limited to, tuberculosis, measles, mumps, rubella, varicella and influenza. The following administrative controls are in place to limit or minimize exposure potential:
There is the potential for exposure to Bloodborne Pathogens if not aware of surroundings at all times. The following administrative controls are in place to limit or minimize exposure potential:
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship