- Identifies patients that need care management services (i.e. utilization review; care coordination; and/or discharge/transition planning).
- Responsible for managing a case load of patients that includes facilitating utilization management, and/or care coordination during the patient's stay, planning and expediting plans for safe and effective discharge and transition to the appropriate level of care and setting needed after hospitalization. Coordinating care by considering all patient's needs.
- Uses critical thinking and effective judgment to determine alternative courses of care. Judiciously uses tools designed to expedite care while being cost effective. Actively participates in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization. Works collaboratively on processes to provide effective transition for patients utilizing hospital outpatient, observation or inpatient services.
- May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved medical necessity screening criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and appropriate reimbursement. Determines and assures appropriate status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff.
- Routinely communicates with payers, patients/family caregivers, physicians, the interdisciplinary team, post-acute and community-based care providers to facilitate coordination of care and to enhance a seamless transition from hospital setting to the appropriate alternative level of care.
- Seeks out information and resources to apply creative problem solving for complex discharge/transition planning, quality of care, and utilization management issues. Provides notification and communication to patients/families regarding coverage for hospital and post-acute services, in accordance with CMS regulations.
- Documents utilization reviews, utilization management actions, care management assessment(s), care plan, discharge plan, and interventions, according to policies, procedures, and regulatory, contractual, and legal requirements. Acts proactively to see that hospital resources are utilized appropriately.
- Works collaboratively with other departments to define areas of hospital inefficiency and participates in improvement projects.
- This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described.
- 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
- Free onsite parking
- Required Bachelor's Degree Graduate of an accredited school of nursing.
- Preferred Will consider non-BSN RN if actively pursuing a bachelor's degree in nursing with completion within 2 years of hire.
- 2 years of relevant experience Minimum two years' experience in the acute care setting. Required
- 3 years of relevant experience Three to five years' experience in care management, utilization review, home care and/or discharge planning. Preferred
- Registered Nurse (RN) - State of Michigan License Upon Hire required
-
Care Coordinator
5 days ago
Advanced Rehabilitation Management Troy, United StatesJob Description · Job DescriptionCare Coordinator- · Medical Case Management · AdvancedRM is a medical case management company with a focus on assisting people with disabilities or injuries return to their maximum level of function following disease or injury. Our team works ext ...
-
Care Coordinator
3 weeks ago
EPIC Health System LLC Clawson, United StatesJob Description · Job DescriptionCare Coordinator · At EPIC Health, we are proud to lead the challenge towards creating healthier communities, one life at a time. We're committed to providing exceptional care to our patients and we're currently seeking an outstanding Care Coordin ...
-
Telephonic Patient Care Coordinator
5 days ago
DirectRx Inc Troy, United StatesWe are a growing dynamic specialty pharmacy that has both full-time and part-time positions available. DirectRx is built on values focused on growth and productivity to help patients Get Better · Team members within this group are responsible for patient care with responsibilitie ...
-
Patient Care Coordinator
3 weeks ago
Specialty1 Partners Bloomfield Hills, United StatesJob Description · Job DescriptionOur office, Endodontic Associates of Michigan - Bloomfield Hills, is seeking a Patient Care Coordinator to join our busy specialty practice. · Our office is looking for a talented and pleasant patient care coordinator to take on all administrativ ...
-
Care Coordinator
1 week ago
PSG Royal Oak, United StatesUnder general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and evaluates appropriateness of admission or continued stay based on medical necessity. The overall g Coordinator, Hospital, Patien ...
-
Customer Care Coordinator
1 week ago
Jushi USA Sterling, United StatesCUSTOMER CARE COORDINATOR · The Customer Care Coordinator will be responsible for being a core member of our patients experience team. Customer Care Coordinatorsare responsible for receiving patients and visitors, ensuring they are compliant for building access as required by the ...
-
Customer Care Coordinator
5 days ago
Jushi Sterling, United StatesJob Description · Job DescriptionCUSTOMER CARE COORDINATOR · The Customer Care Coordinator will be responsible for being a core member of our patients experience team. Customer Care Coordinators are responsible for receiving patients and visitors, ensuring they are compliant for ...
-
Coordinator Managed Care
11 hours ago
McLaren USA Auburn Hills, United StatesWe are looking for a Managed Care Coordinator to join us in leading our organization forward. · McLaren Health Care is one of Michigan's fastest growing health systems. With 15 hospitals, annual revenues of over $6 billion, and a service area that covers 75% of the state of Mich ...
-
Client Care Coordinator
1 week ago
Linchpin Warren, United StatesJob Description · Job DescriptionWe are a dynamic web agency specializing in WordPress website development, seeking a highly motivated individual to join our team as a Client Care Coordinator/ Customer Service Representative. This role is crucial in supporting our day-to-day oper ...
-
Care Coordinator
1 week ago
Help At Home Dearborn, United StatesHelp at Home is hiring Care Coordinator in Michigan · Starting pay ranges $17-$20 an hour · Offering weekly pay · Help at Home is the nation's leading provider of high-quality support services to seniors and people with disabilities. Our clients need us more than ever to continue ...
-
Care Coordinator
2 weeks ago
Centers for Neurosurgery Spine & Orthopedics Wayne, United StatesJob Description · Job DescriptionThe Care Coordinator and Patient Scheduler must possess the desire to help patients secure the care they need using the utmost professionalism, knowledge and compassion. A Care Coordinator must be very aware of the multiple ways a patient might pe ...
-
Patient Care Coordinator
1 week ago
Great Expressions Dental Centers Hazel Park, United States· Patient Coordinator · 2425 Twelve Mile Rd, Warren, MI 48092, USA · Req #464 · Friday, November 10, 2023 · As a Patient Coordinator, you will be the first point of contact for patients visiting or calling the dental office. Your primary responsibility is to provide exceptional ...
-
Clinical - Long Term Care Coordinator 1
3 days ago
Pyramid Consulting Sterling Heights, United StatesImmediate need for a talented Long Term Care Coordinator 1. This is a 05+ Months contract opportunity with long-term potential and is located in FL-Pinellas County and Tampa Bay, include 80%, travel, This position is member facing (Onsite)Please review the job description below a ...
-
Patient Care Coordinator
1 week ago
Corewell Health Farmington, United StatesAbout Farmington Hills Hospital · Recognized by U.S News and World Report as one of the nation's high-performing facilities for multiple procedures and conditions and has been recognized as a Magnet-designed hospital for nursing excellence. This hospital has grown in size and cap ...
-
Customer Care Coordinator
1 week ago
Michigan Humane Detroit, United StatesJob Details · Job Location · Chroma - Remote - Detroit, MI · Remote Type · Fully Remote · Position Type · Full Time · Description · Job Title: Customer Care Coordinator · Location: Fully remote but required to live in Metro Detroit, MI · Hours: Full-Time · Who We Are: ...
-
Residential Care Coordinator
1 week ago
Detroit Wayne Integrated Health Network Detroit, United StatesUnder the general supervision of the Director of Residential Services, the Residential Care Coordinator (RCC) is responsible for overseeing the placement of consumers into the most appropriate residential settings. · PRINCIPAL DUTIES AND RESPONSIBILITIES: · Identifies contracte ...
-
Residential Care Coordinator
5 days ago
Detroit Wayne Integrated Health Network Detroit, United StatesJob Description · Job DescriptionUnder the general supervision of the Director of Residential Services, the Residential Care Coordinator (RCC) is responsible for overseeing the placement of consumers into the most appropriate residential settings. · PRINCIPAL DUTIES AND RESPONSI ...
-
Dental Patient Care Coordinator
1 week ago
Professional Endodontics Southfield, MI, United States Full timeJoin our team and succeed with us Professional Endodontics in Southfield, MI is in search of a Patient Care Coordinator who exhibits quality service, commitment, accountability, and excellence. Our specialty practice is built on integrity, quality, compassion, and putting the pat ...
-
Transition of Care Coordinator
1 week ago
Honest Medical Group Detroit, United StatesJob Description · Job DescriptionWho You AreYou are devoted, compassionate, and enjoy being on the front lines in healthcare, changing the lives of your patients. You are passionate about getting to the root cause of a patient's conditions, removing social determinants of healthc ...
-
Patient Care Coordinator
1 week ago
Great Expressions Dental Centers Novi, United States· Orthodontics Patient Coordinator · Novi, MI, USA · Req #1066 · Wednesday, March 20, 2024 · As a Patient Coordinator, you will be the first point of contact for patients visiting or calling the dental office. Your primary responsibility is to provide exceptional customer servi ...
rn care coordinator - Troy, MI, United States - Corewell Health
Description
About Troy Hospital
Recognized by the US News & World Report as one of the best in the nation for orthopedics and urological services.
This state-of-the-art center provides advanced specialty and routine care with an emphasis on patient satisfaction and a focus on medical advancement.
Scope of workUnder general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and evaluates appropriateness of admission or continued stay based on medical necessity.
The overall goal of the position is to enhance the quality of patient care and engagement, to promote continuity of care and cost effectiveness through the integration and functions of utilization management, and/or care coordination, discharge planning, and appropriate care transitions.
Has accountability for the care coordination and discharge planning of all hospitalized patients.SITE - Troy Hospital Dequindre Road - Troy
Department Name
Care Management - Troy
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8:00 a.m. to 4:30 p.m.
Days Worked
Monday through Friday
Weekend Frequency
Variable weekends
CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community.
We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category.
We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization.
From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do.
We invite those that share in our commitment to join our team.You may request assistance in completing the application process by calling
