Company: Beaumont Hospitals
Posted on: June 6, 2021
Under general direction, integrates cost, quality and
utilization to facilitate the admission, continued stay and
discharge of the patient. Reviews and evaluates appropriateness of
admission or continued stay based on medical necessity. The overall
goal of the position is to enhance the quality of patient care and
engagement, to promote continuity of care and cost effectiveness
through the integration and functions of utilization management,
and/or care coordination, discharge planning, and appropriate care
transitions. Has accountability for the care coordination and
discharge planning of all hospitalized patients.
Identifies patients that need care management services (i.e.
utilization review; care coordination; and/or discharge/transition
Responsible for managing a case load of patients that includes
facilitating utilization management, and/or care coordination
during the patient's stay, planning and expediting plans for safe
and effective discharge and transition to the appropriate level of
care and setting needed after hospitalization. Coordinating care by
considering all patient's needs.
Uses critical thinking and effective judgment to determine
alternative courses of care. Judiciously uses tools designed to
expedite care while being cost effective. Actively participates in
readmission initiatives and strategies to maximize patient flow and
appropriate resource utilization. Works collaboratively on
processes to provide effective transition for patients utilizing
hospital outpatient, observation or inpatient services.
May review cases for medical necessity, uses InterQual and/or
other UR/UM Committee-approved medical necessity screening
criteria, when appropriate. Works collaboratively with
departmental, revenue cycle, and clinical appeals staff,
physicians, and payers to obtain authorization for care and
appropriate reimbursement. Determines and assures appropriate
status and level of care. Uses defined resources to guide
decisions, including Medical Director Care Management, Physician
Advisors, and management staff.
Routinely communicates with payers, patients/family caregivers,
physicians, the interdisciplinary team, post-acute and
community-based care providers to facilitate coordination of care
and to enhance a seamless transition from hospital setting to the
appropriate alternative level of care.
Seeks out information and resources to apply creative problem
solving for complex discharge/transition planning, quality of care,
and utilization management issues. Provides notification and
communication to patients/families regarding coverage for hospital
and post-acute services, in accordance with CMS regulations.
Documents utilization reviews, utilization management actions,
care management assessment(s), care plan, discharge plan, and
interventions, according to policies, procedures, and regulatory,
contractual, and legal requirements. Acts proactively to see that
hospital resources are utilized appropriately.
- Works collaboratively with other departments to define areas of
hospital inefficiency and participates in improvement
A. Education / Training: Graduate of an accredited school of
nursing. Bachelor of Science in Nursing required.
B. Work Experience: Minimum two years' experience in the acute
care setting. Preference three to five years' experience in care
management, utilization review, home care and/or discharge
C. Certification, Licensure, Registration: Requires a current,
unrestricted license to practice as a registered nurse in the State
of Michigan. Certification in care management preferred.
D. Other Qualifications: Working knowledge of 3rd party
requirements, excellent interpersonal and communication skills.
Ability to act in an autonomous, self-directed manner in a
fast-paced, ever-changing environment.
Keywords: Beaumont Hospitals, Taylor , Care Coordinator, Other , Taylor, Michigan
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