RN Care Coordinator

About the Department

Coordinates the care for groups of patients as it relates to disease management resource utilization access discharge planning quality service and efficiently across the continuum. This is an interventional role maintaining a patient centered focus.

Scope of work

Under general direction integrates cost quality and utilization to facilitate the admission continued stay and discharge of the patient. Reviews and evaluates appropriateness of admission or continued stay based on medical necessity. The overall goal of the position is to enhance the quality of patient care and engagement to promote continuity of care and cost effectiveness through the integration and functions of utilization management and/or care coordination discharge planning and appropriate care transitions. Has accountability for the care coordination and discharge planning of all hospitalized patients.

• Identifies patients that need care management services (i.e. utilization review; care coordination; and/or discharge/transition planning).

• Responsible for managing a case load of patients that includes facilitating utilization management and/or care coordination during the patients stay planning and expediting plans for safe and effective discharge and transition to the appropriate level of care and setting needed after hospitalization. Coordinating care by considering all patients 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.

• May review cases for medical necessity uses InterQual and/or other UR/UM Committee-approved medical necessity screening criteria when appropriate. Works collaboratively 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 to enhance a seamless transition from hospital setting to the 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 see that hospital resources are utilized appropriately.

• Works collaboratively with other departments to define areas of hospital inefficiency and participates in improvement projects.

Qualifications

• Required Bachelors Degree Graduate of an accredited school of nursing.

• Preferred Will consider non-BSN RN if actively pursuing a bachelors degree in nursing with completion within 2 years of hire.

• 2 years of relevant experience Minimum two years experience in the acute care setting. Required

• 3 years of relevant experience Three to five years experience in care management utilization review home care and/or discharge planning. Preferred

• Registered Nurse (RN) - State of Michigan Upon Hire required

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!

• Optional identity theft protection home and auto insurance pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Grosse Pointe Hospital - 468 Cadieux - Grosse Pointe

Department Name

Care Management - Grosse Pointe

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:00 a.m. to 4:30 p.m.

Days Worked

Monday to Friday

Weekend Frequency

Variable weekends

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Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace 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 a disability pregnancy or sincerely held religious belief.

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 pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.

An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.

Required Experience:

IC