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Clinical Care Coordinator RN
2 months ago
Job Summary:
The Clinical Care Coordinator RN is a key member of the CHRISTUS Health team, responsible for ensuring the efficient and effective admission and placement of patients within the health system. This role requires strong clinical knowledge, problem-solving skills, and excellent customer service abilities.
Key Responsibilities:
- Review clinical information for patients upon entry into the health system to determine appropriate placement and patient class, maximizing hospital reimbursement and managing length of stay.
- Coordinate with onsite partner providers to review requests for facility services, ensuring appropriate use of outpatient hospital resources.
- Review ED patients identified by treating physicians as requiring admission to the hospital, ensuring appropriate patient class and resource utilization.
- Educate hospital and ED providers on levels of care, resource utilization, payor practices, and documentation, escalating discrepancies to Physician Advisor or CMO as needed.
- Perform initial clinical medical necessity review using evidence-based criteria and enter into the medical record for the receiving CM team.
- Provide after-hour and weekend support to the hospital from a Care Management standpoint, facilitating discharges and responding to physician support needs and inquiries.
- Review post-surgical patients in beds to confirm appropriate patient class/admission status, working with physicians to correct patient class when errors are identified.
- Manage patients in Observation status, reviewing clinical information and opportunities for conversion to inpatient status.
- Collaborate with ED Case Manager on patient class, discharge planning from ED, and avoidance of readmissions.
- Ensure details of incoming communications from payors are entered into the medical record, escalating when indicated.
Requirements:
- Graduate of an accredited school of nursing required.
- Minimum of two years' experience in Case Management and/or Utilization Management required.
- RN License in the state of employment required.
- BLS required.
