RN, Registered Nurse Clinical Care Coordinator - CM Pre-Screening - Full Time

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Job description

Description

Summary:

The Registered Nurse Clinical Care Coordinator is responsible for evaluating, coordinating, processing, screening, and documentation of patient entry into the CHRISTUS Health System. The Registered Nurse Clinical Care Coordinator will collaborate with relevant providers and partners to determine the appropriate patient class and level of care of patients entering the CHRISTUS Health system to ensure the appropriate utilization of resources and maximize appropriate reimbursement opportunities. They will utilize problem-solving and customer service skills to determine the best course of action for the patient, the physician, and the hospital by working closely with facility House Supervisors, referring physicians, ED, and inpatient staff to ensure the effective and efficient admission/placement of every patient. This role requires the full understanding and active participation in fulfilling the Mission of CHRISTUS Health. It is expected that the associate demonstrates behavior consistent with the Core Values. The associate shall support CHRISTUS Health's strategic plan and the goals and direction of their Performance Improvement Plan (PIP).

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Reviews clinical information for patients upon entry into the health system to determine appropriate placement and patient class to maximize appropriate hospital reimbursement and positively manage length of stay.
• Coordinates with onsite partner providers (LTACH, Inpt Rehab) to review requests for facility services and ensure appropriate use of outpatient hospital resources for (their patients) including scheduling coordination and appropriate escort by sending provider.
• Review all ED patients identified by the treating physician as requiring admission to the hospital to ensure appropriate patient class and resource utilization.
• Educates hospital and ED providers on levels of care, resource utilization, payor practices, and documentation. Escalates to Physician Advisor or CMO when discrepancies are present.
• Performs the initial clinical medical necessity review utilizing evidence-based criteria and enters into the medical record for the receiving CM team.
• Provide after-hour and weekend support to the entire hospital from a Care Management standpoint to include facilitating discharges after business hours and responding to physician support needs and inquiries.
• Review all post-surgical patients who are placed in a bed to confirm appropriate patient class/admission status and work with physicians to correct patient class when errors are identified to maximize hospital reimbursement and resource utilization.
• Responsible for 24/7 ongoing management of patients in Observation status to include repeated review of clinical and opportunities for conversion to inpatient status.
• Works closely to coordinate and collaborate with the ED Case Manager regarding patient class, discharge planning from ED, and avoidance of readmissions.
• Ensures the details of incoming communications from payors are entered into the medical record (certifications, authorizations) and escalated when indicated (receipt of denials, deadline for clinical receipt, etc.).

Requirements:

Education/Skills

Graduate of an accredited school of nursing is required.

Experience

Minimum of two (2) years' experience in Case Management and/or Utilization Management is required.

Licenses, Registrations, or Certifications

RN License in the state of employment required.
BLS is required.

Work Schedule:

11p-7a M-F

Work Type:

Full Time

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