Registered Nurse Care Coordinator -40hrs 8:00am - 4:30pm

Registered Nurse Care Coordinator -40hrs 8:00am - 4:30pm Days , 8:00am - 4:30pm Scheduled Hours per Week: 40 hours Position Summary: The RN Care Coordinator is responsible for overseeing the appropriateness of care provided to members of health plans contracted by the hospital and being held accountable for appropriate financial and clinical outcomes of these patients. The RN Care Coordinator will be assigned to selected areas of the Hospital on a rotating basis to perform utilization reviews and other UM activities, as needed, to be based upon department staffing and coverage. The RN CC will support and coordinate the activities of the Social Workers assigned to the unit. As this is an evolving position, duties and responsibilities may vary based on specific assignments. Essential Responsibilities Utilizing InterQual® Level of Care Criteria, ensuring appropriate service assignment (inpatient vs observation) and collaborating with the attending MD to reduce the possibility of reimbursement denials Provides clinical information necessary for authorization to 3rd parties within one business day of request Communicates excess day and/or denial information to the team; resolves delays by negotiating with the team, ancillary services, 3rd parties Rounds with the care team and collaborates with the team to identify patients/families with complex discharge needs. Determines appropriate referrals. Ensures patients are discharged appropriately to alternative sites in a timely manner Qualifications: BSN preferred; Master’s degree preferred (Nursing Masters not required for this advanced degree) Current Massachusetts Nursing license Minimum 5 years clinical nursing experience 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review preferred. Strong verbal and written communications skills Proficiency with computers and an ability to learn new programs with ease. #J-18808-Ljbffr Merrimack Health