Coord RN Care Inpt PRN 2nd 3rd

St. Elizabeth Healthcare; Edgewood (KY); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider in Kentucky is seeking a Care Coordinator to assess patient care needs and coordinate resources effectively. This role requires collaboration with patients and medical staff to ensure compliance and optimal care delivery while navigating insurance intricacies. The ideal candidate will be a licensed RN with strong critical thinking and problem-solving skills, committed to improving patient outcomes.

Qualifications

• Graduate of an accredited baccalaureate nursing or related program.
• Licensed as an RN in the practicing state.
• Meets all licensure and contact hour requirements.

Responsibilities

• Assess care management and compliance with regulatory policies.
• Coordinate patient progression and engage with interdisciplinary teams.
• Manage utilization of benefits and resources during care.

Skills

Critical Thinking

Problem-Solving

Communication

Organizational Skills

Education

Bachelor's Degree in Nursing or related program

Job description

Job Description

The Care Coordinator (CC) utilizes appropriate/standardized criteria to determine the optimal level of care required for the patient and alternative care delivery options.

Responsibilities:

1. Assess the appropriateness of care management, diagnostic testing, clinical procedures, and documentation of medical records on a concurrent basis. Record variances and document reviews in the designated software system.
2. Conduct admission and concurrent medical record reviews using established criteria, ensuring compliance with regulatory and internal policies. Screen for admission appropriateness (IP vs. Observation) and continued stay for medical necessity. Ensure accuracy and completeness of clinical and demographic information.
3. Act as a resource and provide education to staff and physicians regarding resource utilization, discharge planning, and psychosocial aspects of healthcare.
4. Monitor critical care bed utilization.
5. Coordinate patient progression through the continuum of care in collaboration with patients, families, physicians, and the interdisciplinary team. Advocate for patients by coordinating resources during inpatient stays and transitions to post-acute care.
6. Perform initial care management assessments for discharge planning and care coordination.
7. Coordinate and implement discharge plans for patients with post-acute care needs, collaborating with social workers and identifying patients who may benefit from additional support.
8. Engage in ongoing communication with physicians to improve clinical treatment goals and ensure appropriate and timely discharges. Assess biophysical, psychosocial, and environmental needs for discharge planning, making necessary referrals.
9. Provide expertise on managing chronic and complex patients.
10. Develop strategies to reduce unnecessary length of stay and resource consumption, and document outcomes.
11. Assist in developing treatment and discharge strategies for frequently admitted patients.
12. Ensure interventions, treatments, and procedures are properly sequenced and scheduled according to the treatment plan, avoiding delays and payment denials.
13. Identify obstacles to efficient care and patient outcomes, intervening with the healthcare team to address these issues.
14. Coordinate certification requirements, LOS treatment planning, and benefit utilization issues with third-party payers/review agencies. Resolve denials and conflicts over care, service, or payment.
15. Coordinate pre/post-hospital care within the facility, providers, and community services.
16. Manage utilization of benefits and resources during care.
17. Communicate effectively with patients, families, medical staff, caregivers, healthcare team members, and payers regarding the care plan.
18. Negotiate financial arrangements for reimbursement of out-of-network services as needed.
19. Document patient medical necessity criteria and discharge planning activities following departmental policies. Complete data collection via designated software, identify and communicate risk management, quality, and infection control issues, and ensure HIPAA-compliant communication.

Qualifications

Education, Credentials, Licenses: Graduate of an accredited baccalaureate nursing or related program. Licensed as an RN in the practicing state. Meets all licensure and contact hour requirements.

Specialized Knowledge: Knowledge of regulatory issues, payor strategies, benefit plan designs, and policies. Strong organizational, critical thinking, problem-solving, communication, human relations, and team leadership skills.

If you encounter difficulties applying, please contact our recruitment team at [e-mail].