RN Care Coordinator

Corewell Health • Farmington Hills, MI

7d • 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 admission or continued stay based on medical necessity and aims to enhance quality of care and patient engagement, promote continuity and cost effectiveness, and coordinate utilization management, discharge planning, and appropriate care transitions. The position is accountable for care coordination and discharge planning for hospitalized patients.

The coordinator identifies patients who need utilization review, care coordination, or discharge and transition planning, and manages a patient caseload throughout hospitalization. This includes coordinating care around patients’ needs, developing safe and effective discharge plans, and arranging transitions to appropriate post-hospital care settings. The role uses critical thinking and cost-effective tools to support care decisions, patient flow, readmission initiatives, and appropriate resource utilization.

The coordinator may review cases for medical necessity using InterQual or other approved screening criteria, determine appropriate patient status and level of care, and work with clinical, revenue cycle, appeals, physician, and payer partners to obtain authorizations and appropriate reimbursement. The role communicates with patients and families, physicians, interdisciplinary teams, payers, and post-acute and community providers to support coordinated care and seamless transitions. It also provides coverage notifications in accordance with CMS regulations and documents reviews, assessments, care plans, discharge plans, and interventions according to applicable policies and requirements.

The position works collaboratively across departments to identify hospital inefficiencies and participate in improvement projects. It is part time, scheduled for 20 hours per week, with variable shifts and days, including variable weekends. The listed hours of work are 8:00 a.m. to 4:30 p.m. The primary location is Farmington Hills Hospital in Farmington Hills, Michigan.

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) license in the State of Michigan, required upon hire.
• At least one certification from the preferred list is required upon hire; the listed certification details are unspecified.

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.
• Basic Life Support (BLS) certification from the American Red Cross.
• Certified Case Manager (CCM) credential from the Commission for Case Manager Certification.

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 patients’ hospital stays.
• Plan and expedite safe, effective discharges and transitions to appropriate post-hospital levels and settings of care.
• Coordinate care while considering patients’ needs and use critical thinking to evaluate alternative courses of care.
• Use cost-effective tools and participate in readmission initiatives and strategies to support patient flow and appropriate resource utilization.
• Collaborate on processes for effective transitions for patients receiving outpatient, observation, or inpatient services.
• Review cases for medical necessity when appropriate, using InterQual or other approved screening criteria.
• Work with departmental, revenue cycle, clinical appeals, physician, and payer partners to obtain authorization and appropriate reimbursement.
• Determine and assure appropriate patient status and level of care, using defined resources such as the Medical Director Care Management, Physician Advisors, and management staff.
• Communicate with payers, patients and family caregivers, physicians, interdisciplinary teams, and post-acute and community-based providers to coordinate care and transitions.
• Find information and resources to address complex discharge planning, 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, utilization management actions, care management assessments, care plans, discharge plans, and interventions in accordance with policies and applicable 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 with deals on restaurants, phone plans, spas, and other offerings.
• Optional identity theft protection.
• Optional 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