Care Management Coordinator

TriHealth • Oxford, OH

4d • Onsite

About The Position

The Care Management Coordinator is responsible for overseeing the processes and documentation that occur as evidence-based practice is applied at the bedside. This role directs and/or completes all functions of the government and commercial utilization management process. The coordinator assesses and coordinates the implementation of the discharge plan. They collaborate with the multidisciplinary team to assure effective, efficient, appropriate care in order to optimize the health status and assure a smooth transition between levels of care for patients served. Performs utilization review for patients served. Requires weekend, holiday, and off-site commitment, with the exception of Hospice of Cincinnati.

Requirements

• Associate's Degree or Diploma in Nursing
• BLS/CPR (Basic Life Support for Healthcare Providers)
• Registered Nurse
• Excellent communication skills
• Ability to negotiate
• Problem solve
• Establish effective working relationship with members of the healthcare team and external customers
• Knowledge & experience in computer key boarding
• 3-4 years experience Clinical in Nursing

Nice To Haves

• Hires into position (internal and external) required to obtain BSN within 5 years of hire
• Professional organization membership preferred

Responsibilities

• Using current practice guidelines, assesses all patients, evaluating progress toward clinical goals and next level of care. Reassesses as clinical condition changes.
• Complete initial utilization review using Interqual criteria. Take follow-up action to resolve the situation when criteria are not met by implementing and documenting according to the Utilization Review plan.
• Coordinate the development of a comprehensive plan of care through patient/family involvement in an interdisciplinary team process. Ensure the patient's health care goals are met related to evidenced-based quality care.
• Ensure that all commercial and government payment requirements are met for continued stay reviews, and other conditions of participation. Ensure that CMS requirements are met for patient status.

Benefits

• continuing education classes
• formal education leading to advanced degrees
• attainment of specialty certification
• nurse membership in local, regional, and national nursing organizations related to the appropriate nurse specialty
• involvement in activities that better the health of our community
• nursing research activities and use of evidence-based practice

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree