Clinical Care Coordinator RN
2 days ago
The Clinical Care Coordinator RN assumes primary responsibility for documenting medical necessity for inpatient status or observation placement at Steward Health Care. This role communicates with physicians and clinicians to ensure timely and cost-effective care coordination.
KEY RESPONSIBILITIES:
- Utilize a systematic methodology to assess, plan, implement, evaluate, and provide patient care coordination from pre-hospital through post-hospital care.
- Assist in developing physician profiles to identify over/under utilization patterns.
- Support Steward Health Care's goals and objectives while working within regulatory compliance guidelines.
- Collaborate with healthcare disciplines to ensure appropriate and timely services.
- Assess the medical appropriateness, quality, and cost-effectiveness of proposed hospital, medical, and surgical services.
- Collaborate with the multidisciplinary team to assist patients with benefits management.
- Communicate with payers to obtain authorization.
- Identify and plan strategies to optimize inpatient length of stay and resource utilization.
REQUIRED KNOWLEDGE & SKILLS:
- Ability to work competently with computer-based charting and clinical software programs.
- Adaptability to change and good organizational skills required, with the ability to read and communicate effectively in English.
- Ability to do presentations and work with Microsoft Office Products, including Excel, Word, and other software.
- Leadership skills required for mentoring, coaching, counseling, time management, problem solving, and strategic planning.
- Ability to demonstrate initiative and a proactive approach to problem resolution.
- Ability to effectively interact with insurance companies and community healthcare resources.
- Ability to work in a stressful, fast-paced environment.
- Understanding of CMI, patient status, InterQual Criteria, Milliman Criteria, and Transfer DRGs.
EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:
- Education: Bachelor's degree required; Master's degree preferred.
- Experience: Three to five years of acute medical/surgical experience plus three to five years of Case Management experience.
- Certification/Licensure: RN license required; Certification in Case Management (CCM) strongly preferred.
- Software/Hardware: Strong knowledge in Microsoft Office applications.
- Other: Understanding of the healthcare delivery setting.
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