RN - Care Coordinator

Care Manager

Manages patient progression of care. Promotes evidence-based protocols. Ensures the appropriateness of interventions. Expedites care delivery for patients admitted. Directs patient care services to ensure a timely and appropriate patient discharge. Reviews patients' records and evaluates patient progress. Performs continuing review of patient hospitalization to monitor necessity and appropriateness of hospitalization, length of stay, and quality of care. Provides utilization management and review functions for patients admitted to other facilities. Obtains and reviews necessary medical reports and treatment plans as requested by regulatory agencies or payers. Reviews and validates physician orders, reporting progress and unusual occurrences on patients. Works with leadership, clinical care team, and physicians to ensure healthcare services are appropriate and cost-effective. Collaborates with physicians and the clinical care team to ensure adherence to the utilization management/care management plan. Reviews new hospital admissions to assess patient conditions and needs to develop personalized treatment plans. Provides appropriate or required information to patients and/or their families regarding their healthcare benefits. Reviews patient records and participates in interdisciplinary collaboration with professional staff. Ensures maintenance of the utilization review plan in collaboration with the review staff. Facilitates educational programs and advises about regulations affecting utilization management and care management. Directs the coordination of patient care departments, ensuring treatment plans meet patient needs and criteria approved by regulatory or payer requirements. Ensures documentation supports utilization management functions and communicates with payers within required timeframes. Reviews information, communicates results, and enters billing information as appropriate. Prepares information for notification letters to providers, staff, and patients. Receives and processes requests for appeals of denials. Responds to complaints per review guidelines. Maintains utilization review and appeal logs. Supports clinical improvement activities by providing quality review. Performs tumor registry functions. Other duties as assigned.

Active nursing license required. Clinical care or nursing experience. Experience in chart review, risk management, or related quality service.