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- 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 patient’s 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 patient’s 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.
- Required Bachelor's Degree Graduate of an accredited school of nursing.
- Required 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
- LIC-Registered Nurse (RN) - STATE_MI State of Michigan Upon Hire required
- CRT-At least one Certification from preferred list - UNKNOWN Unknown Upon Hire required
- CRT-Basic Life Support (BLS) - AHA American Heart Association preferred Or
- CRT-Basic Life Support (BLS) - ARC American Red Cross preferred
- CRT-Case Manager, Certified (CCM) - CCMC Commission for Case Manager Certification Upon Hire preferred
- Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
- Waist to Waist > 5 lbs: Seldom up to 10 lbs
- Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
- Waist to Overhead > 5 lbs: Seldom up to 10 lbs
- Bilateral Carry > 5 lbs: Seldom up to 10 lbs
- Unilateral Carry > 5 lbs: Seldom up to 10 lbs
- Pushing Force > 5 lbs: Seldom up to 10 lbs
- Pulling Force > 5 lbs: Seldom up to 10 lbs
- Sitting: Occasionally
- Standing: Occasionally
- Walking: Occasionally
- Forward Bend - Standing: Seldom
- Forward Bend - Sitting: Seldom
- Trunk Rotation - Standing: Seldom
- Trunk Rotation - Sitting: Seldom
- Reach - Above Shoulder: Seldom
- Reach - at Shoulder or Below: Seldom
- Handling: Occasionally
- Forceful Grip > 5 lbs: Seldom
- Forceful Pinch > 2 lbs: Seldom
- Finger/Hand Dexterity: Frequently
Primary Location
SITE - Grosse Pointe Hospital - 468 Cadieux - Grosse PointeDepartment Name
Care Management - Grosse PointeEmployment Type
Part timeShift
Day (United States of America)Weekly Scheduled Hours
20Hours of Work
8:00am to 4:30pmDays Worked
VariableWeekend Frequency
Variable weekendsCURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors and community. That is why we require a drug-free workplace and various vaccinations as a requirement for employment.
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.
If you are a qualified individual with a disability, you may request assistance in completing the application process by calling 616.486.7447. We are committed to granting reasonable accommodations in accordance with applicable laws.
More Information
Application Details
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Organization Details
Corewell Health Corporate
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