What are the responsibilities and job description for the RN Care Coordinator position at Spectrum Health?
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.
About Trenton Hospital
This Magnet-designated facility provides comprehensive medical and surgical care for its patients and is one of four recipients of the Truven Health Advantage Award in the category of Health and Clinical Outcomes. It is home to nine university affiliated residency programs. Here, you will find a Level II trauma center that is a nationally recognized heart, vascular and pulmonary specialties along with other specialties like orthopedics, neurosurgery, and women’s health.
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 ( 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.
Qualifications
How Corewell Health cares for you
Comprehensive benefits package to meet your financial, health, and work / life balance goals. Learn more .
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 - Trenton Hospital - 5450 Fort St - Trenton
Department Name
Care Management - Trenton
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
Hours of Work
8 : 00 to 4 : 30
Days Worked
Monday to Friday
Weekend Frequency
Variable weekends
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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.
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