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The Continued Stay Coordinator is responsible for facilitating and coordinating continued stay eligibility determinations to ensure participants remain eligible for services under applicable regulatory, contractual, and organizational requirements. This role conducts periodic functional eligibility reviews, analyzes clinical and non‑clinical information, and collaborates with interdisciplinary teams to support timely, accurate continued stay decisions. The position plays a critical role in regulatory compliance, continuity of care, and audit readiness.
Job Responsibility
Facilitate Continued Stay Reviews (CSRs) by making referrals to agencies for the Level of Care (LOC)
Serve as case manager until certification is obtained for annual continuation of PACE services
Facilitate continued stay reviews in accordance with federal, state, and program-specific eligibility requirements
Conduct periodic functional eligibility reassessments using clinical documentation, assessments, and interdisciplinary input
Collect, review, and analyze supporting medical, functional, and psychosocial information to determine continued eligibility
Coordinate continued stay review schedules and ensure reviews are completed within required timeframes
Prepare and maintain comprehensive eligibility documentation, determinations, and supporting rationale in designated systems
Collaborate with interdisciplinary team members (e.g., clinical staff, care coordinators, social services, enrollment, compliance) to support continued stay determinations
Identify and escalate potential eligibility risks, gaps, or changes in participant status that may impact continued stay
Communicate continued stay outcomes, requirements, and next steps to internal stakeholders and, as appropriate, participants or authorized representatives
Ensure compliance with regulatory standards, program contracts, and organizational policies related to continued stay and eligibility
Support audits, reviews, and appeals by providing accurate documentation and responding to eligibility inquiries
Maintain strict confidentiality of participant information in accordance with HIPAA and organizational standards
Requirements
High school diploma or equivalent
Minimum of two years of experience in eligibility determination, continued stay reviews, utilization review, case management, or related healthcare roles
Nice to have
Associate's or Bachelor's degree in healthcare administration, social work, nursing, public health, or a related field
Experience supporting continued stay, utilization management, or regulatory eligibility reviews in a healthcare setting