Nurse Utilization & Care Coordination Specialist III

UK St. Claire; United States; On-site; USD 34,000 - 55,000; Part time

Job summary

UK St. Claire seeks a healthcare professional to evaluate newly admitted patients, ensure accurate documentation, and designate level of care. The role involves liaison with physicians, nursing staff, social workers, patients, insurers, and government payers to secure care and reimbursement.

You will collaborate on discharge planning and coordinate post-acute services like home health and DME, contributing to safe transitions and quality patient care.

Qualifications

• Education: ADN or equivalent.
• Experience: 3–5 years in a related field.
• Licensure: Nursing license.

Responsibilities

• Assesses all newly admitted patients for appropriate hospitalization, accurate documentation, proper order entry, and correct level of care designation.
• Conducts daily reviews for patients whose payer requires continued review, ensuring medical necessity is documented.
• Collaborates with physicians regarding patient status, level of care, and required documentation to meet medical necessity and payer requirements.
• Serves as liaison with insurance companies, Medicare, and Medicaid to provide timely updates and secure authorizations for continued hospitalization.
• Coordinates with nursing staff and weekend social workers to arrange home health services, DME, and post-discharge resources.
• Supports safe and efficient patient transitions through teamwork and effective communication.
• Performs other duties as assigned.

Education

Associate Degree - ADN

Job description

UK St. Claire seeks a healthcare professional to evaluate newly admitted patients, ensure accurate documentation, and designate level of care. The role involves liaison with physicians, nursing staff, social workers, patients, insurers, and government payers to secure care and reimbursement.

You will collaborate on discharge planning and coordinate post-acute services like home health and DME, contributing to safe transitions and quality patient care.