RN Care Coordinator

Corewell Health • Trenton, MI

13d • 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 reviews the appropriateness of admissions and continued stays based on medical necessity, with the goal of enhancing quality of care and patient engagement, promoting continuity of care and cost effectiveness, and supporting utilization management, care coordination, discharge planning, and appropriate care transitions. The position is accountable for care coordination and discharge planning for hospitalized patients.

The coordinator manages a caseload, identifies patients who need care management services, and facilitates utilization management and care coordination during hospitalization. The role plans and expedites safe, effective discharge and transitions to appropriate levels and settings of care, collaborates with clinical and administrative partners, and documents assessments, reviews, care plans, discharge plans, and interventions in accordance with applicable policies and requirements.

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, and/or discharge or transition planning.
• Manage a patient caseload by facilitating utilization management and care coordination during the stay, and planning and expediting safe, effective discharge and transitions to appropriate care settings.
• Consider patients’ needs when coordinating care and use critical thinking and judgment to determine alternative courses of care.
• Use care-management tools judiciously to expedite care cost-effectively; participate in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization.
• Collaborate on processes that support effective transitions for patients using hospital outpatient, observation, or inpatient services.
• Review cases for medical necessity when appropriate, using InterQual or other approved screening criteria.
• Work with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain care authorization and appropriate reimbursement; determine and assure appropriate patient status and level of care.
• Use defined resources, including the Medical Director of Care Management, Physician Advisors, and management staff, to guide decisions.
• Communicate with payers, patients and family caregivers, physicians, the interdisciplinary team, and post-acute and community-based providers to coordinate care and support seamless transitions.
• Find information and resources to address complex discharge and transition planning, quality-of-care, and utilization-management issues.
• Notify and communicate with patients and families about coverage for hospital and post-acute services in accordance with CMS regulations.
• Document utilization reviews and management actions, care-management assessments, care plans, discharge plans, and interventions in accordance with 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 supporting 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 and home and auto insurance.
• Traditional and Roth retirement options with service contribution and matching savings. Eligibility for benefits depends on employment type and status.

What This Job Offers

• Job Type: Part-time