Nurse Care Navigator: Discharge & Care Coordination

Fairfield Memorial Hospital Association; Fairfield (IL); On-site; USD 47,000 - 63,000; Full time

Job summary

Fairfield Memorial Hospital is seeking a highly organized Registered Nurse to serve as a Nurse Care Coordinator/Discharge Planner, coordinating services across the continuum of care and promoting efficient patient transitions.

The role includes utilization review with InterQual criteria, developing individualized discharge plans, and collaborating with patients, families, providers, payers, and community agencies to ensure appropriate care levels and successful post-discharge outcomes.

Qualifications

• Current Registered Nurse license in Illinois required.
• BSN and CCM certification preferred.
• Experience in Care Management, Discharge Planning, Utilization Review or Care Coordination advantageous.
• Experience with electronic health records (EHR) documentation.
• Strong organizational and communication skills; attention to detail.

Responsibilities

• Coordinate patient care transitions across outpatient, ED, inpatient, Swing Bed, and post-discharge services.
• Perform utilization reviews using InterQual Level of Care criteria.
• Develop discharge plans addressing patient, family, and community needs.
• Monitor resource utilization, length of stay, and readmission risk.
• Communicate with patients, families, providers, payers, and community agencies.
• Educate patients for active participation in their care and self-management.
• Submit clinical documentation to insurers and coordinate authorization and reimbursement.
• Collaborate with Precertification Specialists, HIM, and Revenue Cycle for peer reviews and appeals.
• Manage referrals and authorizations for Swing Bed and post-acute care.

Skills

Organizational skills

Prioritization

Multitasking

Communication

Interpersonal skills

Team collaboration

InterQual criteria

Utilization review

Insurance authorization

Appeals processes

EHR documentation

Attention to detail

Patient advocacy

Quality outcomes

Service excellence

Education

RN license (Illinois)

BSN (preferred)

Case Management certification (CCM/ACM)

Job description

Fairfield Memorial Hospital is seeking a highly organized Registered Nurse to serve as a Nurse Care Coordinator/Discharge Planner, coordinating services across the continuum of care and promoting efficient patient transitions.

The role includes utilization review with InterQual criteria, developing individualized discharge plans, and collaborating with patients, families, providers, payers, and community agencies to ensure appropriate care levels and successful post-discharge outcomes.