RN Care Coordinator

Corewell Health • Trenton, MI

1d • 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 medical necessity and supports quality patient care and engagement, continuity of care, and cost-effective care transitions through utilization management, care coordination, and discharge planning. The position is accountable for care coordination and discharge planning for hospitalized patients.

Requirements

• Bachelor’s degree in nursing; non-BSN RNs will be considered if actively pursuing a bachelor’s degree in nursing, with completion within two years of hire.
• Graduate of an accredited school of nursing.
• 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, preferred.
• Basic Life Support (BLS) certification from the American Red Cross, preferred.
• Certified Case Manager (CCM) credential from the Commission for Case Manager Certification, preferred upon hire.

Responsibilities

• Identify patients who need utilization review, care coordination, or discharge and transition planning.
• Manage a caseload by facilitating utilization management and care coordination during hospitalization and planning safe, effective discharge to the appropriate level and setting of care.
• Coordinate care while considering patients’ needs and use critical thinking and judgment to determine alternative courses of care.
• Use resources and tools to expedite care cost-effectively, support readmission initiatives, improve patient flow, and promote appropriate resource utilization.
• Collaborate on processes that support 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 colleagues to obtain care authorization and appropriate reimbursement.
• Determine and assure appropriate patient status and level of care, using guidance from Care Management Medical Directors, 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 facilitate transitions.
• Find information and resources to address complex discharge planning, care transition, 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 actions, care management assessments, care plans, discharge plans, and interventions in accordance with applicable policies and regulatory, contractual, and legal requirements.
• Promote appropriate use of hospital resources and collaborate with other departments to identify 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 services.
• 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: Part-time
• Career Level: Mid Level