RN Care Coordinator

Corewell Health • Dearborn, MI

13d • Onsite

About The Position

Under general direction, the RN Care Coordinator integrates cost, quality, and utilization to support patient admission, continued stay, discharge, and appropriate transitions of care. The role evaluates medical necessity and helps enhance patient care and engagement, continuity of care, and cost effectiveness through utilization management, care coordination, discharge planning, and care transitions. The position is accountable for care coordination and discharge planning for hospitalized patients.

The coordinator manages a caseload, identifying patients who need utilization review, care coordination, or discharge and transition planning. The role collaborates with patients and families, physicians, interdisciplinary teams, payers, hospital departments, and post-acute and community providers to coordinate care, determine appropriate status and level of care, secure authorization and reimbursement, and plan safe, effective transitions. The coordinator documents reviews, assessments, plans, and interventions in accordance with applicable policies and regulatory, contractual, and legal requirements, and participates in efforts to improve hospital efficiency and patient flow.

Requirements

• Bachelor's degree; graduate of an accredited school of nursing.
• A non-BSN registered nurse may be considered if actively pursuing a bachelor's degree in nursing, with completion within two years of hire.
• At least two years of experience in an acute care setting.
• Registered Nurse (RN) license 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, preferred upon hire.

Responsibilities

• Identify patients who need utilization review, care coordination, discharge planning, or transition planning.
• Manage a caseload by facilitating utilization management and care coordination during hospitalization.
• Plan and expedite safe, effective discharge and transitions to appropriate post-hospital levels of care and settings.
• Evaluate admission and continued-stay appropriateness based on medical necessity; use approved screening criteria such as InterQual when appropriate.
• Determine and ensure appropriate patient status and level of care, using defined resources including the Medical Director Care Management, Physician Advisors, and management staff.
• Coordinate with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain care authorization and appropriate reimbursement.
• Communicate with payers, patients and family caregivers, physicians, interdisciplinary teams, and post-acute and community-based providers to facilitate coordinated care and seamless transitions.
• Provide patients and families with notification and communication 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.
• Use critical thinking and judgment to identify alternative courses of care and apply resources judiciously to support cost-effective care.
• Participate in readmission initiatives and strategies to improve patient flow and appropriate resource utilization.
• Collaborate on processes supporting patients using hospital outpatient, observation, or inpatient services.
• Seek information and resources to solve complex discharge and transition planning, quality-of-care, and utilization management issues.
• Work with other departments to identify hospital inefficiencies and participate in improvement projects.

Benefits

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

What This Job Offers

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