RN Care Coordinator-Care Management-Per Diem-Day Shifts-Weekends As Needed
Position Summary: The RN Care Coordinator is responsible for overseeing the appropriateness of care provided to members of health plans contracted by the hospital and being held accountable for appropriate financial and clinical outcomes of these patients. The RN Care Coordinator will be assigned to selected areas of the Hospital on a rotating basis to perform utilization reviews and other UM activities, as needed based upon department staffing and coverage. The RN CC will support and coordinate the activities of the Social Workers assigned to the unit. As this is an evolving position, duties and responsibilities may vary based on specific assignments.
- Recent experience in acute care setting involved with clinical activities and/or a managed care environment working in case management
- Recent experience in a case management role or related role
- Excellent computer skills including managing work against performance metrics and reporting on key indicators important to the department
Education and Competencies:
- Bachelor’s in Nursing required and Masters preferred ( Nursing Masters not required for this advanced degree)
- InterQual experience
- Strong computer skills with knowledge and proficiency with Microsoft Word, Excel and PowerPoint
- Strong data analytic skills to prepare and monitor management reports regarding the performance of the areas assigned and the Department
- Demonstrated experience with managing against clinical and financial indicators and performance goals
- Demonstrated skills in working collaboratively with physicians, managers and other team members
- Demonstrated skills in organizing and directing staff teams to complete assignments accurately and on time
- Exempt position
- Current licensure in Massachusetts as a Registered Nurse
- Case Management Certification preferred
- Evidence of continued professional development
Perform InterQual reviews on assigned patients and working with insurers to provide clinical information, answer questions, obtain insurance authorization for patients.
Support Social Workers (SW) Care Coordinator on the floor who will be responsible for the development and execution of patient discharge plans.
- Help the SW Care Coordinators prioritize work and/or support clinically difficult discharge plans with the Social Workers.
- Prepare and review reports on the Department’s performance including but not limited to - LOS, clinical denials and appeal status, avoidable days, time of discharge, proper level of documentation.
- Work with Care Coordination Manager/Director to develop educational needs and identify strategies to accomplish objectives of the Department.
- Given this job position is a new position; additional tasks may be added as the position is further developed.