RN Care Coordinator

3 weeks ago

Harrisburg, Pennsylvania, United States Highmark Health Full time
Job Summary

Frequent travel and virtual visits in an assigned territory are key components of this role. As a RN Care Coordinator, you will be responsible for coordinating care and managing the coordination of care in accordance with recognized standards of practice for Care Management.

This role requires expertise in care management to promote a collaborative professional environment that supports excellence of care and achievement of optimal resource utilization. You will also facilitate appropriate Length of Stay (LOS), patient satisfaction, and reimbursement for all patients.

Essential Responsibilities
  1. Assume a role in assessing patient physical, psychosocial, and economic needs for effective transition of care planning to a variety of levels of care.
  2. In collaboration with the care team, facilitate the development and communication of the continuum of care transition plan to appropriate health service providers.
  3. Document, verify, and validate specific data required to monitor and evaluate interventions and outcomes. Interview and collect patient-specified data and chart review related to readmission.
  4. Be knowledgeable of and comply with accreditation and regulatory requirements. Integrate performance improvement principles and customer service principles into all aspects of job responsibilities.
  5. Obtain or ensure acquisition of appropriate pre-certification authorizations from third-party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third-party guidelines.
  6. Obtain or facilitate acquisitions of urgent/emergent authorizations, continued stay authorizations, and authorizations for post-acute services as needed and with compliance with all regulatory and contractual requirements.
  7. Document, monitor, intervene/resolve, and report clinical denials/appeals and retrospective payer audit denials. Collaboratively formulate plans of action for denial trends with the care coordination teams, performance improvement teams, physicians/physician advisor, and third-party payers.
  8. Maintain a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc.
  9. Serve as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adhere to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies.
  10. Communicate telephonically and electronically with outpatient providers in an effort to enhance the continuum of care.
  11. Assume responsibility for AHN required continued education and own professional growth.
Education

Required:

  • Bachelor's Degree in Nursing
  • 6 years of related and progressive experience in lieu of Bachelor's degree

Preferred:

  • None
Experience

Required:

  • 2 years of recent clinical RN Acute care, Home care, Palliative, Hospice, or Care Management

Preferred:

  • Discharge planning and community resource knowledge
  • Care facilitation and utilization review experience
Licenses or Certifications

Required:

  • RN license in appropriate state based on location
  • CPR Certification

Preferred:

  • None
Skills
  • Motivational interviewing competency
  • Advance care planning competency
  • Ability to work in a high-performing team environment that requires flexibility
  • Excellent organizational and time management skills
  • Competent computer skills, including Microsoft Office products
Language (Other than English)

None

Travel Requirement

50% - 75%

Physical, Mental Demands, and Working Conditions

Position Type:

  • Office-based
  • Teaches/trains others regularly

Occasionally:

  • Travel regularly from the office to various work sites or from site-to-site
  • Works primarily out-of-the office selling products/services (sales employees)

Never:

  • Physical work site required

Lifting:

  • Up to 10 pounds: Constantly
  • 10 to 25 pounds: Rarely
  • 25 to 50 pounds: Never

Exposure to:

  • Blood, body fluids, or tissue: Occasionally
  • Needles or sharps: Occasionally
Disclaimer

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title.

It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct.

This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum

$57,700.00

Pay Range Maximum

$106,700.00

Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.

The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity, or any other category protected by applicable federal, state, or local law.

Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status, or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity

We endeavor to make this site accessible to any and all users.

If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID:

J250711

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