RN Utilization Management Referral Coordinator

About Helen DeVos Children’s Hospital

We fight for every child. With 350 pediatric specialists and subspecialists, 12 years of U.S. News & World Report national rankings and innovations that draw patients from all over the world, we're driven to replace fear with hope and doubt with answers. We believe in the possibility of every child's future. Because it's only impossible until it isn't. We have both inpatient and ambulatory spaces as well as a Level 1 trauma Emergency Department designated to children.

Scope of work

Supporting the essential referral, admission and insurance coordination functions for the first Pediatric Med Psych hospital in the state of Michigan. Manage all components of referral management, admission waiting list, insurance prior authorizations, continuous stay reviews and appeals. Additional support to the UM functions of the Corewell Health South Behavioral Health Inpatient unit.

• Assesses internal and external referrals to identify patient/significant others’ needs, level of intensity, insurance benefits and other patient resources.
• Develops plan of care and makes recommendations to PCPs, specialists and other members of the health care team regarding care management strategies, identifying strategies to maximize continuity of care across the continuum.
• Assesses the educational needs of patients, families and members of the health care team and develops and implements appropriate teaching strategies or makes appropriate referrals.
• Communicates and collaborates with patient/significant others/providers/payers to coordinate services that improve access to appropriate services across the continuum of care and which promotes optimal health in a cost-effective manner.
• Measures patient care outcomes, interprets reports and analyzes data trends for groups of patients.
• Documents patient data, plan, interventions and outcomes according to department guidelines.

How we will care for you, while you care for our patients

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings

Qualifications

• Required Bachelor's Degree or equivalent nursing or a healthcare related field (all departments except Spectrum Health Ludington) BSN must be obtained within 7 years for those who start in this RN role on or after January 1, 2017 (Spectrum Health Ludington Hospital) Required.
• 2 years of relevant experience clinical nursing and or case management/managed care or related field Required
• 5 years of relevant experience clinical nursing and or case management/managed care or related field Preferred
• Registered Nurse (RN) - State of Michigan Upon Hire required
• Basic Life Support (BLS) - AHA American Heart Association Ambulatory Care Management Upon Hire required Or
• Basic Life Support (BLS) - ARC American Red Cross Ambulatory Care Management Upon Hire required
• Case Manager, Certified (CCM) - CCMC Commission for Case Manager Certification Upon Hire preferred