RN, Registered Nurse Clinical Care Coordinator - Case Management - Full Time at CHRISTUS St. Michael Health System

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Summary:

The Registered Nurse Clinical Care Coordinator is responsible for establishing, coordinating, and maintaining the process to increase patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum for the ED. The RN Clinical Care Coordinator collaborates with the patient and/or family, multidisciplinary team, physicians, community partners, and payers to ensure the patient’s progress and level of care are appropriately determined and evaluates or screens patients entering the CHRISTUS Health System for medical necessity. The RN Clinical Care Coordinator will collaborate with relevant providers and partners to determine the appropriate patient class and level of care of patients entering the CHRISTUS Health system to ensure the appropriate utilization of resources and maximize appropriate reimbursement opportunities. The RN Clinical Care Coordinator will utilize problem-solving and customer service skills to determine the best course of action for the patient, the physician, and the hospital by working closely with facility House Supervisors, referring physicians, ED, and inpatient staff to ensure the effective and efficient admission/placement of every patient. This job requires the full understanding and active participation in fulfilling the Mission of CHRISTUS Health. It is expected that the associate demonstrates behavior consistent with the Core Values. The associate shall support CHRISTUS Health’s strategic plan and the goals and direction of their Performance Improvement Plan (PIP).

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Reviews clinical information for patients upon entry into the health system to determine appropriate placement and patient class to maximize appropriate hospital reimbursement and positively manage length of stay.
• Coordinates with onsite partner providers (LTACH, Inpt Rehab) to review requests for facility services and ensure appropriate use of outpatient hospital resources for (their patients) including scheduling coordination and appropriate escort by sending provider.
• Review all ED patients identified by the treating physician as requiring admission to the hospital to ensure appropriate patient class and resource utilization.
• Educates hospital and ED providers on levels of care, resource utilization, payor practices, and documentation. Escalates to Physician Advisor or CMO when discrepancies are present.
• Performs the initial clinical medical necessity review utilizing evidence-based criteria and enters into the medical record for the receiving CM team.
• Utilizes high risk screening criteria to make appropriate community and post-ED referrals.
• Initiates prior authorization process when indicated for post-ED referrals and services.
• Escalates to physician advisor when unable to resolve discrepancies with the attending physician.
• Manages high-use patients and works to find alternatives for care to frequent ED visits.
• Plans for discharges from the ED for patients who do not require admission to include arranging for Home Health, DME, placement, and community resources as they relate to social determinants of health.
• Provides patient and family education and counseling about existing health problem related care.
• Anticipates barriers/variances to the delivery of care and intervenes as necessary.
• Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes.
• Coordinates and facilitates patient progression throughout the continuum.
• Collaborates with all members of the interdisciplinary team to facilitate appropriate care coordination and care delivery.

Job Requirements:

Education/Skills

• Graduate of an accredited school of nursing required

Experience

• 2 years of experience in Case Management and/or Utilization Management required

Licenses, Registrations, or Certifications

• RN License in the state of employment required
• BLS required

Work Type:

Full Time - Weekend Option Day Shift

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