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. Directs and or completes all functions of the government and commercial utilization management process. Assesses and coordinates implementation of the discharge plan. Collaborates 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.
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.
Requirements
- Associate's Degree or Diploma in Nursing
- Hires into position (internal and external) required to obtain BSN within 5 years of hire
- 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
- Professional organization membership preferred
