RN Care Coordinator

Corewell Health • Royal Oak, MI

1d • Onsite

About The Position

Royal Oak Hospital, recognized by U.S. News & World Report as a top hospital in Michigan and the country, is a major academic and referral center with Level I adult and Level II pediatric trauma designations. This Magnet-designated center, housing Michigan’s first Diagnostic Imaging Center of Excellence, seeks an RN Care Coordinator. Under general direction, this role integrates cost, quality, and utilization to facilitate patient admissions, continued stays, and discharges. The primary goal is to enhance patient care quality and engagement, promote continuity of care, and ensure cost-effectiveness through utilization management, care coordination, discharge planning, and appropriate care transitions. The RN Care Coordinator is accountable for the care coordination and discharge planning of all hospitalized patients.

Requirements

• Bachelor's Degree
• Graduate of an accredited school of nursing.
• Minimum two years’ experience in the acute care setting.
• Three to five years’ experience in care management, utilization review, home care and/or discharge planning.
• Registered Nurse (RN) - State of Michigan License Upon Hire

Nice To Haves

• Will consider non-BSN RN if actively pursuing a bachelor’s degree in nursing with completion within 2 years of hire.

Responsibilities

• Identifies patients needing care management services (utilization review, care coordination, discharge/transition planning).
• Manages a caseload of patients, facilitating utilization management and/or care coordination during their stay, and planning/expediting safe discharge and transition to the appropriate level of care and setting.
• Uses critical thinking and judgment to determine alternative courses of care, judiciously using cost-effective tools.
• Actively participates in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization.
• Works collaboratively on processes for effective patient transitions utilizing hospital outpatient, observation, or inpatient services.
• May review cases for medical necessity using InterQual and/or other approved criteria.
• Works collaboratively with departmental, revenue cycle, clinical appeals staff, physicians, and payers to obtain authorization and reimbursement.
• Determines and assures appropriate status and level of care, using resources like the Medical Director Care Management, Physician Advisors, and management staff.
• Routinely communicates with payers, patients/family caregivers, physicians, the interdisciplinary team, and post-acute/community-based care providers to facilitate coordination and seamless transitions.
• Seeks out information and resources for creative problem-solving in 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 assessments, care plans, discharge plans, and interventions according to policies and requirements.
• Acts proactively to ensure appropriate utilization of hospital resources.
• Works collaboratively with other departments to identify hospital inefficiencies and participates in improvement projects.

Benefits

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

What This Job Offers

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