Clinical Care Coordinator Specialist

22 hours ago


Philadelphia, Pennsylvania, United States Children's Hospital of Philadelphia Full time
Job Description
As a Registered Nurse Case Manager Inpatient, you will play a critical role in coordinating patient care and ensuring seamless transitions between hospital services. Your primary responsibility will be to assess patient needs, develop effective discharge plans, and collaborate with interdisciplinary teams to achieve optimal outcomes.

You will work closely with patients, families, and healthcare professionals to identify potential barriers to care and implement strategies to overcome them. Your expertise will be instrumental in promoting efficient resource utilization, reducing readmissions, and enhancing overall patient satisfaction.

Responsibilities:
  • Determines medical necessity, appropriateness of admission, continuing stay, and level of care using clinical information, clinical criteria, and third-party information.
  • Validates admission and continuing stay criteria with third-party payers and attending physicians.
  • Collaborates with third-party payers to prevent denial of payment and proactively addresses issues contributing to a potential denial.
  • Supports the effective prevention and management of denials, including providing requested information as part of the appeal process.


Required Skills and Qualifications:
  • Registered Nurse (Pennsylvania) license upon hire.
  • At least five years of experience in nursing, preferably in a pediatric setting or similar adult setting.
  • Excellent communication and organizational skills, with the ability to work effectively with all departments and levels of CHOP professionals.


Benefits:
  • Competitive salary range ($85,000 - $110,000 per year).
  • A comprehensive benefits package, including medical, dental, and vision insurance.
  • Retirement savings plan with employer match.
  • Generous paid time off and holidays.




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