RN Care Coordinator

Corewell Health • Farmington Hills, MI

5d • Onsite

About The Position

Under general direction, the RN Care Coordinator integrates cost, quality, and utilization to support patient admission, continued stay, and discharge. The role evaluates medical necessity and aims to enhance patient care quality and engagement, continuity of care, and cost effectiveness through utilization management, care coordination, discharge planning, and appropriate care transitions.

The position is accountable for care coordination and discharge planning for hospitalized patients. It identifies patients who need care management services and manages a caseload throughout their stay, facilitating utilization management and care coordination, and planning safe, effective discharge and transition to the appropriate level of care. The coordinator considers patients’ needs, applies critical thinking to identify alternatives, and uses resources judiciously to support cost-effective care.

The coordinator participates in readmission initiatives and strategies to improve patient flow and resource utilization, and collaborates on effective transitions for patients receiving outpatient, observation, or inpatient services. The role may review cases for medical necessity using InterQual or other approved screening criteria. It works with departmental, revenue cycle, clinical appeals, physician, and payer partners to obtain authorization and appropriate reimbursement, and determines and assures appropriate patient status and level of care.

The role routinely communicates with payers, patients and family caregivers, physicians, interdisciplinary teams, and post-acute and community-based providers to coordinate care and support seamless transitions. It seeks resources and creative solutions for complex discharge planning, quality, and utilization issues; informs patients and families about coverage in accordance with CMS regulations; and documents reviews, assessments, care plans, discharge plans, and interventions according to applicable policies and regulatory, contractual, and legal requirements. The coordinator also helps ensure appropriate use of hospital resources and participates in improvement projects addressing hospital inefficiencies.

This is a part-time position scheduled for 20 hours per week, with variable shifts and variable weekends. The listed hours of work are 8:00 a.m. to 4:30 p.m.

Requirements

• Bachelor’s degree; graduate of an accredited school of nursing.
• Non-BSN registered nurses 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 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) certification from the Commission for Case Manager Certification.

Responsibilities

• Integrate cost, quality, and utilization to facilitate patient admission, continued stay, and discharge.
• Review and evaluate the appropriateness of admission or continued stay based on medical necessity.
• Identify patients who need utilization review, care coordination, discharge planning, or transition planning services.
• Manage a caseload by facilitating utilization management and care coordination throughout patients’ stays.
• Plan and expedite safe, effective discharges and transitions to the appropriate level of care and setting.
• Coordinate care while considering patients’ needs and use critical thinking to determine alternative courses of care.
• Use tools and resources judiciously to expedite care cost-effectively.
• Participate in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization.
• Collaborate on effective transitions for patients receiving hospital outpatient, observation, or inpatient services.
• Review cases for medical necessity using InterQual or other approved criteria when appropriate.
• Work with departmental, revenue cycle, clinical appeals, physician, and payer staff to obtain authorization and appropriate reimbursement.
• Determine and assure appropriate patient status and level of care, using defined resources such as the Medical Director of 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 and apply creative problem-solving to complex discharge planning, quality-of-care, and utilization management issues.
• Provide patients and families with information about coverage for hospital and post-acute services in accordance with CMS regulations.
• Document utilization reviews, utilization management actions, assessments, care plans, discharge plans, and interventions according to policy 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 offers on restaurants, phone plans, spas, and other items.
• 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