Under the general supervision of the director acts as a patient advocate/outcomes coordinator to hospital clients.  Applies review criteria to determine medical necessity for admission. Provides clinically-based case management, discharge planning, care coordination, clinical documentation and quality initiatives to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care.

Coordinates, negotiates, procures, and manages the care of complex patients to facilitate achievement

of quality and cost effective patient outcomes. Works collaboratively with interdisciplinary staff internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care. The outcomes coordinator is on-site and available during scheduled work hours.

• Assesses clinical including psychosocial system parameters.
• Establishes planning to determine goals, objectives and care setting and admit status

   to optimally meet patient needs.

• Conducts necessary conferences and team meetings regarding specific patient needs.
• Implements interventions that lead to patient accomplishing goals established in plan.
• Coordinates the necessary resources to accomplish goals developed in plan.
• Proactively affects system to facilitate efficient flow of care.
• Gathers information from sources to enable outcomes manager to monitor the plan’s effectiveness.
• Evaluates the effectiveness of the plan (including variance) in reaching patient’s outcomes and goals.
• Monitors and facilitates the assignment and conversion of observation status patients per policy.
• Makes appropriate changes to plan as necessary
• Assigns working DRG based on concurrent review of the record and identifies the documentation needed to support the DRG assigned.
• Abstracts pertinent information from the medical record to accurately complete CDP worksheet

• Registered nurse graduate of an approved program.
• BSN preferred. Associate Degree with 5 years clinical experience or CM certification or coding certification may be considered.