Registered Nurse Clinical Care Coordinator

Northwell Health; Baywood (NY); On-site; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare provider in Baywood is seeking a dedicated Clinical Care Coordinator. The role involves evaluating patients, coordinating discharge plans, and collaborating with healthcare professionals to ensure optimal patient care. Ideal candidates will have a nursing background and experience in utilization management. Join our team to make a difference in patient outcomes and support our commitment to quality care.

Qualifications

• Minimum of two years of medical/surgical experience in an acute-care hospital.
• Experience in utilization management/discharge planning preferred.

Responsibilities

• Performs concurrent reviews on all patients and shares problematic cases.
• Identifies problematic care patterns and makes referrals.
• Consults with physicians on patient care aspects.

Skills

Communication

Collaboration

Education

High School Diploma

Bachelor's Degree in Nursing

Job description

Job Description

Evaluates and assesses patients admitted to the hospital.

Job Responsibilities

1. Performs concurrent reviews on all patients and shares problematic cases with the Supervisor and Physician Advisor.
2. Determines and makes appropriate referrals concerning the alternate level of care.
3. Processes adverse determination decisions to the Physician Advisor and distributes notifications as appropriate.
4. Identifies problematic care patterns or cases and makes referrals to the Supervisor and involved departments.
5. Performs retrospective reviews as required.
6. Participates in maintaining Utilization Management, Discharge Planning, and Case Management statistics.
7. Keeps abreast of policy and procedure changes related to Utilization Management, Discharge Planning, and Case Management.
8. Attends Utilization Management Committee and other staff meetings as required.
9. Participates in ALC meetings and Interdisciplinary Patient Care Rounds.
10. Identifies services or treatments that may not be medically necessary and refers to the Physician Advisor.
11. Consults with physicians and healthcare professionals on patient care aspects.
12. Makes referrals to hospital departments for collaboration in discharge planning.
13. Implements and documents discharge plans in the patient's medical record.
14. Schedules family/patient conferences to coordinate safe and timely discharge plans.
15. Collaborates with professional personnel to assess patients for alternative care and notifies relevant departments.
16. Refers patients requiring institutional placement to the Social Work Department.
17. Acts as a liaison with insurance carriers to coordinate post-hospital services and referrals.
18. Arranges post-discharge services such as home care, hospice, equipment, and supplies.
19. Assists in identifying patient incidents through the NYPORTS program.
20. Performs Clinical Care Coordination assessments within 72 hours of admission and ongoing reviews every 48 hours or as needed.
21. Communicates with physicians to clarify documentation regarding severity of illness and quality of care.
22. Keeps updated on changes in insurance policies affecting documentation, utilization, and case management.
23. Shares problematic cases with the Supervisor of CM-CCC and makes referrals as needed.
24. Performs any related duties as required.

ADA Essential Functions

Job Qualifications

• High School Diploma or equivalent required; Bachelor's Degree in Nursing or related field preferred.
• Current license to practice as a Registered Nurse in New York State.
• Minimum of two years of medical/surgical experience in an acute-care hospital; experience in utilization management/discharge planning preferred.

Additional Salary Details: The listed salary range or hourly rate is a good faith estimate of potential compensation and may be adjusted in the future. Factors such as location, experience, education, credentials, and internal policies may influence the final salary.