RN Care Coordinator

About the Role

Under general direction, integrates cost, quality, and utilization to facilitate the admission, continued stay, and discharge of the patient. Reviews and evaluates the appropriateness of admission or continued stay based on medical necessity. The overall goal is to enhance the quality of patient care and engagement, promote continuity of care, and ensure cost-effectiveness through utilization management, care coordination, discharge planning, and appropriate care transitions.

Accountable for the care coordination and discharge planning of all hospitalized patients. Identifies patients needing care management services (utilization review, care coordination, and/or discharge/transition planning). Manages a caseload of patients by facilitating utilization management and/or care coordination during their stay, planning and expediting safe and effective discharge, and transitioning to the appropriate level of care post-hospitalization.

Coordinates care by considering all patient needs, using critical thinking and effective judgment to determine alternative courses of care. Utilizes tools designed to expedite care while being cost-effective. Actively participates in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization. Collaborates on processes to provide effective transitions for patients utilizing hospital outpatient, observation, or inpatient services.

May review cases for medical necessity using InterQual or other UR/UM Committee-approved medical necessity screening criteria. Collaborates with departmental, revenue cycle, clinical appeals staff, physicians, and payers to obtain authorization for care and appropriate reimbursement. Determines and ensures appropriate status and level of care, using defined resources such as 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 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, contractual, and legal requirements. Acts proactively to ensure hospital resources are utilized appropriately. Collaborates with other departments to define areas of inefficiency and participates in improvement projects.

Requirements

• Bachelor's Degree from an accredited school of nursing (Required). Non-BSN RNs considered if actively pursuing a Bachelor's degree in nursing with completion within 2 years of hire.
• Minimum two years’ experience in the acute care setting (Required).
• Three to five years’ experience in care management, utilization review, home care, and/or discharge planning (Preferred).
• Registered Nurse (RN) - State of Michigan (Required upon hire).
• Basic Life Support (BLS) - AHA American Heart Association or ARC American Red Cross (Preferred).
• Case Manager, Certified (CCM) - CCMC 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 a.m. to 4:30 p.m.
• Weekly scheduled hours: 40.
• Days worked: Monday to Friday.
• Weekend frequency: Every fourth weekend.

Primary Location: SITE - Troy Hospital - 44201 Dequindre Rd, Troy. Department: Care Management - Troy Hosp.