TOC Care Management Coordinator

Admission & Discharge Management Reconcile RHIO and Hamaspik Central alerts daily to identify Emergency Department, Observation, Inpatient, Skilled Nursing Facility (SNF), Behavioral Health, and Rehabilitation admissions and discharges.

Distribute daily admission and discharge notifications to the Medicare TOC Team and Utilization Management.

Monitor admissions and discharges throughout the day and communicate significant updates to the TOC team.

Care Coordination Contact hospitals, Skilled Nursing Facilities (SNFs), rehabilitation centers, and other facilities to obtain member status updates.

Monitor anticipated discharge dates and communicate discharge readiness to the assigned TOC RN.

Notify the TOC RN of changes in member status, barriers to discharge, and important clinical updates requiring intervention.

Coordinate with facility staff to obtain discharge plans and discharge disposition.

Schedule timely post-discharge appointments with Primary Care Providers (PCPs).

Schedule specialty appointments as requested to support continuity of care.

Coordinate communication between facilities, providers, TOC Nurses, Care Managers, Utilization Management, and other interdisciplinary team members.

Assist in removing barriers that may delay discharge or impact a successful transition back to the community.

Support continuity of care by ensuring appropriate follow-up services are coordinated after discharge.

Guiding Care Documentation Create, update, and close Service Interruptions (SI) for Emergency Department, Observation, Inpatient, SNF, Behavioral Health, and Rehabilitation stays.

Complete MAP and DSNP Hospitalization/SNF/Behavioral Health Admission Notification scripts accurately and within required timeframes.

Verify facility information using NPPES and authorization records.

Maintain complete, accurate, and timely documentation within Guiding Care.

Provider Notifications Prepare and fax Notifications of Admission (NOA), Transfers, and Discharges to Primary Care Providers within required timeframes.

Upload notifications and fax confirmations into Guiding Care.

Obtain missing PCP contact information when necessary.

Ensure discharge summaries and supporting documentation are forwarded to PCPs in accordance with HEDIS Transitions of Care requirements.

Discharge Summary Coordination Request and obtain discharge summaries from hospitals and facilities.

Perform ongoing follow-up until discharge summaries are received.

Review discharge summaries to ensure required HEDIS Transitions of Care elements are present.

Coordinate with TOC Nurses and Utilization Management regarding missing or incomplete discharge documentation.

Ensure discharge documentation is distributed timely to PCPs.

Internal Workflow Coordination Generate and assign activities for interruption of services during inpatient admissions.

Generate notification of change in member status activities to assigned Care Managers.

Generate resumption of services activities following member discharge...