RN Care Coordinator
Core
RN Care Coordinator integrating cost, quality, and utilization to facilitate patient admission, continued stay, and discharge while ensuring medical necessity and appropriate care transitions.
Role type
RN Care Coordinator (Utilization Management)
Builds
Safe and effective discharge plans and transitions to post-acute/community care
Domain
Healthcare / Utilization Management
Required skills
Utilization review, Care coordination, Discharge planning, Medical necessity determination, InterQual criteria application, Payer communication, Regulatory compliance (CMS), Case load management
Preferred skills
Care management, Home care, Quality improvement projects
Technologies
InterQual, CMS regulations
Responsibilities
Review and evaluate appropriateness of admission or continued stay based on medical necessity; Identify patients needing care management services; Manage case load for utilization management and discharge planning; Collaborate with physicians, payers, and interdisciplinary teams to obtain authorization; Document utilization reviews and care plans; Communicate coverage and transition plans to patients/families; Participate in readmission initiatives and process improvement projects.