RN Care Coordinator, Case Management, Per Diem, Days and Weekends
RN Care Coordinator, Case Management, Per Diem, Days and Weekends
Posted on :
27-08-2025
Employer Active
1 Vacancy
Job Alert
You will be updated with latest job alerts via emailValid email field required
Send jobs
Share
Send me jobs like this
Job Alert
You will be updated with latest job alerts via emailValid email field required
Send jobs
Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
27-08-2025
Job Description
Overview
You Matter Here!
Heywood Healthcare values our employees! We offer competitive wages great benefits and generous earned time off. Come work where you will matter!
Hours: Per Diem Days and Weekends
Responsibilities
Essential Functions:
- Utilization Management- Utilization Review and Care Transitions & Coordination
Providing clinical information to payers monitoring length of stay seeking necessary care authorizations and utilizing the InterQual Program; appealing denials as indicated within a timely fashion. - Reviews all new admissions and Observation patients within 24 hours of admission against High Risk Screening Criteria and documents outcome within the UM EMR.
- Completes assessments on re-admissions within 30 days including reasoning for re-admission documents findings and provides data to the department for stratifying data.
- Follows-up on lack of documentation for medical necessity supporting documentation with discipline identified. Track
and trend opportunities for improvement resulting in late Insurance Reviews longer lengths of stay; including educating providers to Interqual Criteria used for determining Admission or Observation status. - Completes utilization reviews daily and/or as required by insurer (concurrent and retro) for medical and/or psychiatric appropriateness according to Hospitals approved criteria timely and efficiently.
- Assesses intervenes evaluates and determines level of care to establish accurate admission and/or observation status; demonstrates basic knowledge of DRG reimbursement evidenced by standardized measures for length of stay and acuity level status designation.
- Demonstrates clinical expertise specific to the issuance of ABN/HINN notice to patients and/or legal significant other and care progression. Keeping physician and team informed of status change and documenting status.
- Provides education and information to patient family and care providers as it pertains to continuing care
care management LOS re-hospitalization and assure understanding of disease management - Multidisciplinary Team Rounds-participates in discharge planning rounds daily.
- Works collaboratively with multidisciplinary team to determine each patients needs concurrently including post-acute care when needed; addresses LOS issues appropriate leveling of patient status; addresses
potential needs resources referrals for other disciplines etc. - Quality & Statistical Data: Reviews medical record for abnormal findingscomplications delays and deviations from expected clinical outcomes reports such to Provider and/or Director to maintain an efficient cost effective episode of care for each patient and documents intervention provided.
- Acquires knowledge to keep up with changes in technology and regulations.
- Utilizes knowledge to redesign systems for improving performance.
- Continuously prioritizes projects activities and tasks to ensure deadlines and customer needs are met.
- Assists with preparation of reports/statistics as it pertains to staff specific workflow.
- Denials/Appeal Process: Completes assessment of denial within 1 week providing supporting documentation with outcome of review; documents intervention in the UR EMR section.
- Prepare written appeal letters termination letters discharge notices MOON and IMs when appropriate as per regulatory standards and department policies. Report any variances trends to director. Submits denials/appeals when completed to the department secretary for processing.
- Discharge Planning:
Communication: builds rapport and responds to needs of physician reviewers for managed care plans healthcare team members 3rd party payers outside reviewers and vendors to enhance internal and external customer service satisfaction. - Responsible for completing nursing sections of the SNF Level of Care forms for Mass Health patients in need of care
SNF placement timely and efficiently and other forms assisting in transition of care as identified and collaborates with the social the event of an emergency Care Coordinator may complete the form in full and process it to help expedite discharge planning process and length of stay. - The Discharge Planning Process:
Completes discharge planning assessments timely efficiently and completely following regulatory standards and departmental policies assuring appropriate patient flow. Appropriately levels patient for home discharge with or without services or to another type of facility such as a SNF Acute Rehab etc. Develops coordinates and implements discharge plan on cases assigned with patient and/or family/so caregiver. - Identifying patient preference and selection choice for HHA/SNF placements having patient preference form checked off and signed/dates by patient and/or so. When plan is in place notify provider establish and determine anticipated readiness for discharge keeping patient/family/so informed and documenting such in the EMR. Closes case out using appropriate forms for transition of care communication timely and efficiently.
- The Care Coordinator collaborates with the team to assist the Multidisciplinary Team in providing discharge planning activities to assist in expediting a patients discharge as part of the care transitions process. It is the expectation that the Care Coordinator remains current and proficient in the discharge planning process in the event coverage is needed.
- Performs any and all other duties as assigned by director and/or designee.
Statement of Other Duties:
This document describes the major duties and responsibilities for this job and is not intended to be a complete list of all tasks and functions. It should be understood therefore that employees may be asked to perform job-related duties beyond those explicitly described.
Functional Demands
Physical Requirements:
Exerts 20 to 50 pounds of force occasionally and/or up to 10 to 25 pounds of force frequently and/or greater than negligible up to 10 pounds of force constantly to move objects. Frequently reaches (extending hands and arms in any direction) handles (seizing holding grasping turning or working with hands) and feels (perceiving attributes of items such as size shape temperature or texture by means of fingertips). Occasionally stoops (bending the body downward and forward by bending the spine at the waist) and kneels (bending the legs at knee to come to rest on knee or knees).
Organizational Expectations
Behavioral Attributes:
The following behavioral attributes are required: achievement motivation flexibility concern for order initiative self-confidence self control customer service orientation interpersonal effectiveness teamwork and information seeking.
Qualifications
Job Requirements
Minimum Education
- BSN preferred
Minimum Work Experience
- Previous UR/QA experienced required
- 2 years of healthcare experience within the Acute Care SNF HHA Behavioral Health and/or Insurance Industry preferred
Minimum License and Certifications
- Current Massachusetts Registered Nurse License
Required Skills
- Interqual experience or equivalent preferred
- Meditech Expanse experience preferred
- Proficient computer skills required
- Must have effective written verbal and interpersonal communication skills
- Excellent critical thinking
- Ability to multitask and flexibility essential
- Discharge planning experience as it pertains to the care transitions referral process patient preference/choice services patient & family satisfaction post discharge follow-up etc.
Required Experience:
IC
Employment Type
Grant
Key Skills
Report This Job
Disclaimer: Drjobpro.com is only a platform that connects job seekers and employers. Applicants are advised to conduct their own independent research into the credentials of the prospective employer.We always make certain that our clients do not endorse any request for money payments, thus we advise against sharing any personal or bank-related information with any third party. If you suspect fraud or malpractice, please contact us via contact us page.
