COMPLETE RN Care Coordinator - SITE - Royal Oak Hospital - 3601 W 13 Mile Road - Royal Oak

GENERAL SUMMARY:

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.

ESSENTIAL DUTIES:

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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

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

This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described.

STANDARD QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

A. Education / Training:

· Graduate of an accredited school of nursing. Bachelors of Science in Nursing degree required. Will consider non-BSN RN if actively pursuing a Bachelors degree in nursing with completion within 2 years of hire.

B. Work Experience:

· Minimum two years’ experience in the acute care setting. Preference three to five years’ experience in care management, utilization review, home care and/or discharge planning.

C. Certification, Licensure, Registration:

· Requires a current, unrestricted license to practice as a registered nurse in the State of Michigan. Certification in care management preferred.

D. Other Qualifications:

· Working knowledge of 3rd party requirements, excellent interpersonal and communication skills. Ability to act in an autonomous, self-directed manner in a fast-paced, ever-changing environment.

Corewell Health offers a comprehensive benefits package to meet your financial, health and life-work balance goals.

• NEW On-demand pay program – powered by Payactiv
• Generous paid time off, holidays and flexible scheduling
• Our employees receive special discounts on a wide range of products and services
• Exceptional health, dental, vision and prescription drug insurance plans
• Relocation assistance
• Generous retirement savings, disability insurance, identify theft protection and even home and auto insurance

Our diverse and talented teams of professionals and clinicians don’t just share in the success of our system; they make it possible. Driven by our shared commitment to making our communities healthier and stronger, we are leading the way in health care innovation with relentless ambition and a belief that anything is possible when we work together. 

This is where extraordinary begins. Find out where it can take you and your career.  Apply Now!

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. 

Primary Location

SITE - Royal Oak Hospital - 3601 W 13 Mile Road - Royal Oak

Department Name

Care Management - Royal Oak

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

Rotating

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. 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.