RN Care Managment Coordinator

Intepros seeks an RN Care Managment Coordinator to collaborate with one of our healthcare clients remotely. Must have a PA rn license.

Under the direction of a designated Care Management and Coordination Supervisor, the RN Care Management Coordinator performs telephonic or onsite reviews of hospital admissions, determining alternative settings when appropriate. This role aims to add value to healthcare by promoting efficient and high-quality use of the healthcare delivery system. The coordinator encourages timely and dynamic discharge planning to facilitate early discharges and refers cases to Case Management as needed. Effective collaboration with the hospital utilization review department, attending physicians, and members/families is essential.

DUTIES AND RESPONSIBILITIES:

• Perform utilization management for inpatient admissions, either onsite or telephonically.
• Utilize medical software criteria to establish the need for inpatient admission, continued stay, and length of stay.
• Direct the delivery of care to the most appropriate setting while maintaining quality standards.
• Contact attending physicians regarding treatment plans and clarify the medical necessity for inpatient stay or continued inpatient care.
• Identify inpatient admissions that no longer meet criteria and refer cases to plan Medical Directors for evaluation.
• Present cases to Medical Directors that do not meet established criteria, providing pertinent information regarding the member's medical condition and potential home care needs.
• Early identification of hospitalized members to evaluate discharge planning needs.
• Collaborate with hospital case management staff, physicians, and families to determine alternative settings and support discharge to the most appropriate setting.
• Identify and refer cases for case management and disease management.
• Identify quality of care issues, including delays in care, and appropriately refer cases to the Quality Management Department and/or Care Management and Coordination Supervisor.
• Maintain the integrity of system information through timely, accurate data entry. Ensure utilization decisions comply with state, federal, and accreditation regulations.
• Build relationships with all providers and deliver exceptional customer service.
• Report potential utilization issues or trends to the designated supervisor, providing recommendations for improvement.
• Participate in the process of educating providers on managed care.
• Perform additional related duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

Education and Experience:

• Registered Nurse (BS preferred).
• Minimum of three (3) years of acute care clinical experience in a hospital or other healthcare setting.
• Prior discharge planning and/or utilization management experience is desirable.
• Driver’s License and access to an automobile required.

Skills:

• Exceptional communication skills at all levels.
• Strong problem-solving ability.
• Excellent organizational and team management skills.
• Team player.