• Utilizes MSW education and experience to perform telephonic and onsite assessments of medically complex pediatric recipients in the PDN coordinate the care program.
• As part of the multidisciplinary team, regularly meets with the team and contributes to the development of a comprehensive plan of case based on the needs of the patient and family.
• Utilizes independent judgement to evaluate and modify the plan of care as needed. Regularly communicates changes to the family, healthcare team, and other agencies involved.
• Collaborates with the family and healthcare team to arrange for identified home care needs.
• Consults on patient care issues in area(s) of expertise. Functions as a resource to the community in areas of expertise. Documents all patient care activities appropriately.
• Manage daily workload associated with quality review process, including facilitation of case assignments and follows up to ensure that all cases requiring additional assistance or coordination are completed within timelines required by contract.
•  Prioritizes and addresses requests and assignments in a professional manner to develop cooperative relationships and to ensure that customer confidentiality is assured.

· Maintains system for tracking all incoming and outgoing correspondence in accordance with timelines and requirements of contract.

· Reviews documentation and prepares outgoing correspondence and notifications to physicians and provider representatives in accordance with policy and contract requirements.

• Assists with the coordination and facilitation of Physician Peer to Peer conferences as necessary.

• Review incoming referrals and peer determinations and directs questionable referrals and/or determinations to appropriate manager for follow up.

• Functions as expert resource to external customers.

• Actively participates in ongoing development, implementation, and evaluation of effectiveness of the program process, and works with management staff to formulate recommendations for process modifications when indicated.

• Actively participates in internal initiatives, functioning as expert resource for other staff. Participates in gathering information/data for CMS reporting.

• Assists in the initial and ongoing training of nurses and coordinators regarding the process and other issues relevant to coordination of care.

• Provides courteous and prompt service to all internal and external customers. 

• Identifies opportunities and recommends methods to improve service, work processes and financial performance.