RN Care Coordinator

Under general direction, integrates cost, quality, and utilization to facilitate the admission, continued stay, and discharge of patients. Reviews and evaluates the appropriateness of admission or continued stay based on medical necessity. The role enhances the quality of patient care and engagement, promotes continuity of care, and ensures cost-effectiveness through utilization management, care coordination, discharge planning, and appropriate care transitions.

Responsibilities

• Accountable for care coordination and discharge planning of all hospitalized patients.
• Identifies patients needing care management services, including utilization review, care coordination, and/or discharge/transition planning.
• Manages a caseload of patients by facilitating utilization management, care coordination during their stay, and planning for safe, effective discharge or transition to appropriate levels of care.
• Coordinates care by considering all patient needs and uses critical thinking to determine alternative courses of care.
• Uses tools designed to expedite care while ensuring cost-effectiveness.
• Actively participates in readmission initiatives and strategies to maximize patient flow and resource utilization.
• Collaborates on processes to provide effective transitions for patients utilizing hospital outpatient, observation, or inpatient services.
• Reviews cases for medical necessity using InterQual or other UR/UM Committee-approved criteria.
• Works collaboratively with departmental, revenue cycle, clinical appeals staff, physicians, and payers to obtain authorization for care and appropriate reimbursement.
• Determines and ensures appropriate patient status and level of care using defined resources, including Medical Director Care Management, Physician Advisors, and management staff.
• Communicates routinely with payers, patients/families, physicians, interdisciplinary teams, post-acute, and community-based care providers to facilitate care coordination and seamless transitions.
• Seeks 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 assessments, care plans, discharge plans, and interventions according to policies, procedures, and regulatory requirements.
• Acts proactively to ensure appropriate utilization of hospital resources.
• Collaborates with other departments to identify areas of hospital inefficiency and participates in improvement projects.

Requirements

• Bachelor's Degree from an accredited school of nursing (Required).
• Non-BSN RNs may be considered if actively pursuing a Bachelor's degree in nursing with completion within 2 years of hire.
• Minimum two years of experience in the acute care setting (Required).
• Three to five years of experience in care management, utilization review, home care, and/or discharge planning (Preferred).
• Registered Nurse (RN) license in the State of Michigan (Required upon hire).
• Basic Life Support (BLS) certification from the American Heart Association (AHA) or American Red Cross (ARC) (Preferred).
• Certified Case Manager (CCM) from the Commission for Case Manager Certification (Preferred upon hire).

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.

Schedule

• Full-time, day shift (8:00 AM to 4:30 PM).
• 40 hours per week.
• Days worked: Monday through Friday.
• Weekend frequency: Variable weekends.

Primary Location: SITE - Dearborn Hospital - 18101 Oakwood Blvd, Dearborn.