RN, Registered Nurse Clinical Care Coordinator - Case Management

Responsibilities

• Reviews clinical information for patients upon entry into the health system to determine appropriate placement and patient class to maximize appropriate hospital reimbursement and positively manage length of stay.
• Collaborates with onsite partner providers (LTACH, Inpt Rehab) to review requests for facility services and ensure appropriate use of outpatient hospital resources for (their patients) including scheduling coordination and appropriate escort by sending provider.
• Coordinates with onsite partner providers (LTACH, Inpt Rehab) to review requests for facility services and ensure appropriate use of outpatient hospital resources for (their patients) including scheduling coordination and appropriate escort by sending provider.
• Reviews all ED patients identified by the treating physician as requiring admission to the hospital to ensure appropriate patient class and resource utilization.
• Educates hospital and ED providers on levels of care, resource utilization, payor practices, and documentation. Escalates to Physician Advisor or CMO when discrepancies are present.
• Performs the initial clinical medical necessity review utilizing evidence-based criteria and enters into the medical record for the receiving CM team.
• Utilizes high risk screening criteria to make appropriate community and post-ED referrals.
• Initiates prior authorization process when indicated for post-ED referrals and services.
• Escalates to physician advisor when unable to resolve discrepancies with the attending physician.
• Manages high-use patients and works to find alternatives for care to frequent ED visits.
• Plans for discharges from the ED for patients who do not require admission to include arranging for Home Health, DME, placement, and community resources as they relate to social determinants of health.
• Provides patient and family education and counseling about existing health problem related care.
• Anticipates barriers/variances to the delivery of care and intervenes as necessary.
• Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes.
• Collaborates with all members of the interdisciplinary team to facilitate appropriate care coordination and care delivery.

Qualifications

• Graduate of an accredited school of nursing required.
• Experience 2 years of experience in Case Management and/or Utilization Management required.
• RN License in the state of employment required.
• BLS required.

Work Schedule

MULTIPLE SHIFTS AVAILABLE

Work Type

Part Time