RN Care Coordinator

Scope of Work Integrates cost, quality, and utilization to facilitate admission, continued stay, and discharge of patients. Reviews and evaluates appropriateness of admission or continued stay based on medical necessity. Enhances quality of patient care, engagement, continuity of care, and cost effectiveness through utilization management, care coordination, discharge planning, and appropriate care transitions. Provides accountability for care coordination and discharge planning of all hospitalized patients. Identifies patients that need care management services (utilization review, care coordination, and/or discharge/transition planning). Manages a case load of patients, facilitating utilization management and/or care coordination during the patient’s stay, and planning safe and effective discharge and transition to appropriate level of care and setting after hospitalization. Coordinates care considering all patient 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. Reviews cases for medical necessity, using InterQual and/or other UR/UM Committee-approved medical necessity screening criteria, when appropriate. Collaborates 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 enhance a seamless transition from hospital to 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 ensure hospital resources are utilized appropriately. Works collaboratively with other departments to define areas of hospital inefficiency and participates in improvement projects. Qualifications Required: 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 required Basic Life Support (BLS) from either the American Heart Association or the American Red Cross. Preferred: Will consider a non‑BSN RN if actively pursuing a bachelor’s degree in nursing with completion within two years of hire. Case Manager, Certified (CCM) – CCMC Commission for Case Manager Certification upon hire. Benefits Comprehensive benefits package to meet your financial, health, and work/life balance goals, including health coverage, a retirement plan, on‑demand pay, discounts, optional identity theft protection, and home and auto insurance. Location & Work Schedule Site: Royal Oak Hospital – 3601 W 13 Mile Rd, Royal Oak, MI Department: Care Management – Royal Oak Hospital Employment Type: Full Time, Day Shift (8:00a.m. to 4:30p.m.) Schedule: Monday to Friday (variable weekends) Equal Employment Opportunity Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender identity or expression, veteran status, or any other legally protected category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to disability, pregnancy, or sincerely held religious belief. Join Our Team If you require assistance completing the application process, please call View phone number on click.appcast.io. #J-18808-Ljbffr