05/01/1986 39310

PATIENT CARE COORDINATOR

DEFINITION: This is responsible and professional administrative work, planning and coordinating the utilization review function at a state hospital, state general hospital, or restoration center.

An employee in this class is responsible for administering, planning and coordinating the utilization review program at a state hospital, state general hospital, or restoration center. Work involves reviewing, analyzing and evaluating patient records to determine the medical necessity for hospital admissions and the appropriateness of admissions and extended stays. Work includes monitoring admissions to assure the review of extended stays on a timely basis, and maintaining liaison with patient care providers and those responsible for discharge planning to facilitate continuity in patient care. Work is performed with considerable independence under the supervision of the Chairman of the Utilization Review Committee. Work is reviewed for conformance with established criteria, standards, and procedures as set forth in the hospital's utilization review plan and Federal and state rules, regulations, policies, and procedures.

EXAMPLES OF WORK: Administers, plans, and coordinates the utilization review program in a state hospital, state general hospital, or restoration center.

Reviews, analyzes and evaluates patients' records to determine the medical necessity for hospital admissions and the appropriateness of admissions and extended stays.

Assigns lengths of stay to those admissions determined to be medically necessary and appropriate.

Monitors admissions to assure that extended stays are reviewed on a timely basis; certifies additional extended stay periods when determined to be medically necessary.

Refers difficult or questionable admissions or extended stays to the Utilization Review Chairman or the physician designee.

Collects and records all information and data needed for admission or extended stay review.

Maintains close liaison with those responsible for discharge planning, patient care, medical records, social services, other allied medical services, individuals and the community, to assure continuity of patient care.

Initiates or coordinates discharge planning, as required.

Attends meetings of the Utilization Review Committee to provide supportive data, makes recommendations on case disposition to committee.

Assists in the conduct of medical care evaluation studies.

Prepares and disseminates reports pertinent to the hospital's utilization review program.

Performs related work as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of Federal and state rules, regulations, policies, and procedures relative to Medicare and Medicaid programs in regard to medically necessary hospital admissions and appropriate extended stays.

Knowledge of medical and psychiatric terminology, treatment modalities, appropriate levels of care, and health care delivery systems.

Knowledge of Departmental rules, regulations, policies, and procedures regarding level of care and available services for patients.

Knowledge of the basic principles and practices of administration.

Ability to read, interpret, analyze, and evaluate medical records to determine the medical necessity and appropriateness of hospital admission or extended stays and to assign appropriate length of stay.

Ability to plan and coordinate the timely review of service utilization with other patient care and treatment programs.

Ability to read and interpret policies, procedures, rules and regulations.

Ability to collect and record information necessary to review hospital admissions and extended stays.

Ability to assist with the conduct of medical care evaluation studies.

Ability to initiate and coordinate discharge planning.

Ability to identify questionable patterns of hospital admission, extended stays and patient care.

Ability to prepare comprehensive reports on patient care, service utilization, hospital admissions and extended stays and present recommendations to the Utilization Review Committee, its chairman, or the physician designee.

Ability to establish and maintain effective working relations with professional and non-professional personnel in patient care and treatment programs; the members of the Utilization Review Committee; Federal, state and community representatives; and physicians, patients, and their families.

Ability to express ideas clearly and concisely, both orally and in writing.

MINIMUM EXPERIENCE AND TRAINING: One year as a Psychiatric Nurse 2 in a state hospital or a Nurse 2 in a State General Hospital or Restoration Center;

or

Three years of professional psychiatric nursing or general nursing, including one year at an advanced level in a state hospital, general hospital or Restoration Center; and graduation from an approved school of professional nursing;

or

Two years of professional social or rehabilitative work, including one year of clinical experience in a supervisory, administrative or consultative capacity in a state hospital, state general hospital or Restoration Center; and a bachelor's degree with major course work in social work, nursing, health care administration, behavioral sciences or related fields;

or

Any equivalent combination of experience and training.