RN Care Coordinator Lead
Company: Beaumont Health
Location: Royal Oak
Posted on: August 6, 2022
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Job Description:
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.
In addition to the above, acts as the lead for the team members in
the day to day operations of the department.ESSENTIAL DUTIES:1.
Assumes the role of lead care coordinator, addressing concerns and
issues from the team members and with any care management related
issues. Is the first line of support for the care management team
and site leaders.2. Identifies patients that need care management
services (i.e. utilization review; care coordination; and/or
discharge/transition planning).3. 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.4. 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.5. 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.6. 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.7. 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.8. 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.9. 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
REQUIREMENTS:1. Supports the Mission, Value and Vision of Beaumont
Health (BH). Demonstrates personal commitment through active
involvement in the performance improvement process.2. Exhibits
excellent customer service skills and behaviors toward internal and
external customers and co-workers. Promotes positive public
relations with patients/residents, family members, guests, and
others.3. Supports and adheres to all Beaumont Health's customer
service, service excellence, and performance standards. Supports
and participates with all required compliance standards that may be
department specific and/or identified by the organizations
including in-service training, acceptable attendance, uniform and
dress code.4. Adheres to HIPAA requirements and maintains
confidentiality of all data, including patient/resident, employee
and operations information.5. Supports and participates in a
collaborative team-oriented environment - cooperates and works
together with all co-workers, plans and completes job duties, uses
appropriate communications in sensitive and emotional situations
and follows up as appropriate regarding reported complaints,
problems and concerns.6. Supports, cooperates with and demonstrates
safe work practices and attitudes, follows safety rules - including
universal precautions - reports and prevents/corrects unsafe
conditions and behaviors, and participates in organizational and
departmental safety programs.7. Completes all required compliance
standards that may be department specific and/or identified by the
organization.8. Maintains current licensure, registration and/or
certification, as applicable, at all times.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. Bachelor of Science in Nursing degree
required.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.
Keywords: Beaumont Health, Royal Oak , RN Care Coordinator Lead, Healthcare , Royal Oak, Michigan
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