RN Care Coordinator: Care Continuum & Discharge Planning

Doctors Hospital of Williamsburg; Williamsburg (VA); On-site; USD 54,000 - 73,000; Full time

Job summary

Riverside Health System in Williamsburg, VA is seeking an experienced Registered Nurse to join the Case Management/Utilization Review team. You will collaborate with physicians and the care team to coordinate patient care across the continuum, assess medical necessity, and ensure safe, cost-effective hospitalization and discharge planning.

BSN required; licensed RN in Virginia; three or more years of clinical experience; strong knowledge of Medicare/Medicaid, and payer processes.

Qualifications

• BSN required.
• Three or more years of clinical experience.
• Knowledge of Medicare/Medicaid and payer requirements.

Responsibilities

• Build trusting, collaborative relationships with staff, peers, physicians and other disciplines.
• Complete problem-solving cycle from identification to resolution to maximize opportunities.
• Collaborate with physicians to ensure compliance with care assessments and utilization criteria.
• Assess patient records for medical necessity of acute hospital stay and LOS assignment.
• Perform utilization reviews in line with the Utilization Management Plan.
• Communicate updates to payers for authorization of hospital stay.
• Assist with discharge planning and coordination of home health and DME.

Skills

Interdisciplinary collaboration

Utilization review

Discharge planning

Quality improvement

Education

BSN (Required)

RN license - Virginia

Job description

Riverside Health System in Williamsburg, VA is seeking an experienced Registered Nurse to join the Case Management/Utilization Review team. You will collaborate with physicians and the care team to coordinate patient care across the continuum, assess medical necessity, and ensure safe, cost-effective hospitalization and discharge planning.

BSN required; licensed RN in Virginia; three or more years of clinical experience; strong knowledge of Medicare/Medicaid, and payer processes.