RN Care Coordinator

Corewell Health • Troy, MI

11h • Onsite

About The Position

Under general direction, the RN Care Coordinator integrates cost, quality, and utilization to facilitate patient admission, continued stay, and discharge. The role evaluates appropriateness of admission and continued stay based on medical necessity, with the overall goal of improving patient care and engagement, continuity of care, and cost effectiveness through utilization management, care coordination, discharge planning, and appropriate transitions of care.

The coordinator is accountable for care coordination and discharge planning for hospitalized patients, identifying those who need utilization review, care coordination, or discharge and transition planning. The role manages a caseload throughout hospitalization, supports safe and effective discharge to the appropriate level and setting of care, and considers patients’ overall needs when coordinating care. The coordinator uses critical thinking, judgment, and available resources to guide decisions and address complex care management issues.

The position works collaboratively with hospital departments, revenue cycle and clinical appeals staff, physicians, payers, patients and caregivers, interdisciplinary teams, and post-acute and community-based providers. It supports appropriate status and level-of-care decisions, authorization and reimbursement, readmission initiatives, patient flow, and resource utilization. The coordinator documents reviews, assessments, care plans, discharge plans, and interventions in accordance with applicable policies and regulatory, contractual, and legal requirements. The position is based at Troy Hospital, is full-time, and works a day shift, 40 hours per week, Monday through Friday, with variable weekends.

Requirements

• Bachelor’s degree; graduate of an accredited school of nursing. A non-BSN RN may be considered if actively pursuing a bachelor’s degree in nursing and completing it within two years of hire.
• At least two years of experience in an acute care setting.
• Registered Nurse (RN) licensure in the State of Michigan, required upon hire.

Nice To Haves

• Three to five years of experience in care management, utilization review, home care, and/or discharge planning.
• Basic Life Support (BLS) certification from the American Heart Association or American Red Cross.
• Certified Case Manager (CCM) credential from the Commission for Case Manager Certification.

Responsibilities

• Integrate cost, quality, and utilization to facilitate patient admission, continued stay, and discharge.
• Review and evaluate admission and continued-stay appropriateness based on medical necessity; use InterQual or other approved medical-necessity screening criteria when appropriate.
• Identify hospitalized patients needing utilization review, care coordination, and/or discharge or transition planning.
• Manage a caseload and facilitate utilization management and care coordination during patients’ stays.
• Plan and expedite safe, effective discharge and transition to the appropriate post-hospital level and setting of care.
• Coordinate care with consideration for each patient’s needs; use critical thinking and judgment to determine alternative courses of care.
• Use available tools and resources to expedite care cost-effectively and make decisions, including consultation with the Medical Director Care Management, Physician Advisors, and management staff.
• Participate in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization.
• Collaborate on processes supporting effective transitions for patients receiving outpatient, observation, or inpatient services.
• Work with hospital departments, revenue cycle and clinical appeals staff, physicians, and payers to obtain care authorization and appropriate reimbursement.
• Routinely communicate with payers, patients and family caregivers, physicians, interdisciplinary teams, and post-acute and community-based care providers to coordinate care and support seamless transitions.
• Find information and resources and apply creative problem-solving to complex discharge and transition planning, quality-of-care, and utilization management issues.
• Notify and communicate with patients and families regarding coverage for hospital and post-acute services in accordance with CMS regulations.
• Document utilization reviews, utilization management actions, care management assessments, care plans, discharge plans, and interventions according to policies, procedures, and regulatory, contractual, and legal requirements.
• Act proactively to ensure appropriate use of hospital resources.
• Collaborate with other departments to identify hospital inefficiencies and participate in improvement projects.

Benefits

• Comprehensive benefits package intended to support financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv.
• Discounts directory offering deals on restaurants, phone plans, spas, and other items.
• Optional identity theft protection, home insurance, and auto insurance.
• Traditional and Roth retirement options with service contribution and matching savings.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level