RN Care Coordinator

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

The coordinator manages a caseload that may include utilization management, care coordination during hospitalization, and planning and expediting safe, effective discharge to the appropriate post-hospital level of care and setting. The role collaborates with patients and families, physicians, interdisciplinary teams, payers, hospital departments, and post-acute and community-based providers. It documents reviews, assessments, care plans, discharge 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 RN 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 for 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 care management services, including utilization review, care coordination, and discharge or transition planning.
• Manage a caseload by facilitating utilization management and/or care coordination during patients’ stays.
• Plan and expedite safe, effective discharge and transitions to the appropriate level and setting of care, considering patients’ needs.
• Use critical thinking and judgment to determine alternative courses of care and use tools to expedite care cost-effectively.
• Participate in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization.
• Collaborate on processes supporting effective transitions for patients using hospital outpatient, observation, or inpatient services.
• Review cases for medical necessity when appropriate, using InterQual and/or other approved screening criteria.
• Work with departmental, revenue cycle, clinical appeals staff, physicians, and payers to obtain care 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, the interdisciplinary team, and post-acute and community-based providers to coordinate care and support seamless transitions.
• Find information and resources to solve 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 addressing financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv.
• Discounts directory for 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: Full-time
• Career Level: Mid Level