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
Registered Nurse (RN) Care Coordinator / Utilization Management Specialist
Builds
Safe and effective discharge plans and transitions to post-acute/community care settings
Domain
Healthcare / Acute Care / Utilization Management
Required skills
Critical thinking, Medical necessity assessment, Care coordination, Discharge planning, Interdisciplinary collaboration, Regulatory compliance (CMS), Resource utilization analysis, Documentation, Payer communication, Case load management
Preferred skills
Case Manager Certification (CCM), Basic Life Support (BLS), Experience in home care or discharge planning
Technologies
InterQual, CMS regulations, Electronic Health Records (implied by documentation)
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 care coordination; Coordinate safe and effective discharge and transition to appropriate levels of care; Communicate with payers, patients/families, physicians, and interdisciplinary teams; Document utilization reviews, care plans, and interventions; Participate in readmission initiatives and process improvement projects.