RN Care Coordinator

Corewell Health • Royal Oak, MI

1d • Onsite

About The Position

Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and evaluates appropriateness of admission or continued stay based on medical necessity. The overall goal of the position is to enhance the quality of patient care and engagement, to promote continuity of care and cost effectiveness through the integration and functions of utilization management, and/or care coordination, discharge planning, and appropriate care transitions. Has accountability for the care coordination and discharge planning of all hospitalized patients. Identifies patients that need care management services (i.e. utilization review; care coordination; and/or discharge/transition planning). Responsible for managing a caseload of patients that includes facilitating utilization management, and/or care coordination during the patient’s stay, planning and expediting plans for safe and effective discharge and transition to the appropriate level of care and setting needed after hospitalization. Coordinating care by considering all patient’s needs. Uses critical thinking and effective judgment to determine alternative courses of care. Judiciously uses tools designed to expedite care while being cost effective. Actively participates in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization. Works collaboratively on processes to provide effective transition for patients utilizing hospital outpatient, observation or inpatient services. May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved medical necessity screening criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and appropriate reimbursement. Determines and assures appropriate status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff. Routinely communicates with payers, patients/family caregivers, physicians, the interdisciplinary team, post-acute and community-based care providers to facilitate coordination of care and to enhance a seamless transition from hospital setting to the appropriate alternative level of care. Seeks out information and resources to apply creative problem solving for complex discharge/transition planning, quality of care, and utilization management issues. Provides notification and communication to patients/families regarding coverage for hospital and post-acute services, in accordance with CMS regulations. Documents utilization reviews, utilization management actions, care management assessment(s), care plan, discharge plan, and interventions, according to policies, procedures, and regulatory, contractual, and legal requirements. Acts proactively to see that hospital resources are utilized appropriately. Works collaboratively with other departments to define areas of hospital inefficiency and participates in improvement projects.

Requirements

• Bachelor's Degree
• Graduate of an accredited school of nursing.
• Will consider non-BSN RN if actively pursuing a Bachelors degree in nursing with completion within 2 years of hire.
• Minimum two years’ experience in the acute care setting.
• Registered Nurse (RN) - STATE_MI Upon Hire
• Basic Life Support (BLS) - AHA or American Red Cross preferred
• Case Manager, Certified (CCM) - CCMC Upon Hire preferred

Nice To Haves

• Three to five years’ experience in care management, utilization review, home care and/or discharge planning.

Responsibilities

• Facilitates the admission, continued stay, and discharge of patients.
• Reviews and evaluates the appropriateness of admissions or continued stays based on medical necessity.
• Enhances the quality of patient care and engagement.
• Promotes continuity of care and cost-effectiveness through utilization management, care coordination, discharge planning, and care transitions.
• Manages a caseload of patients, facilitating utilization management and care coordination.
• Plans and expedites safe and effective discharge and transition to the appropriate level of care.
• Considers all patient needs in care coordination.
• Uses critical thinking and effective judgment to determine alternative courses of care.
• Uses tools designed to expedite care while being cost-effective.
• Participates in readmission initiatives and strategies.
• Works collaboratively on processes for effective patient transitions.
• Reviews cases for medical necessity using InterQual and/or other approved screening criteria.
• Obtains authorization for care and appropriate reimbursement by working with staff, physicians, and payers.
• Determines and assures appropriate patient status and level of care.
• Uses defined resources to guide decisions.
• Communicates with payers, patients/family caregivers, physicians, the interdisciplinary team, and post-acute and community-based care providers.
• Applies creative problem-solving for complex discharge/transition planning, quality of care, and utilization management issues.
• Provides notification and communication to patients/families regarding coverage for hospital and post-acute services.
• Documents utilization reviews, utilization management actions, care management assessments, care plans, discharge plans, and interventions.
• Acts proactively to ensure hospital resources are utilized appropriately.
• Works collaboratively with other departments to define areas of hospital inefficiency and participates in improvement projects.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings

What This Job Offers

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