Job Description
**Description**
_**Summary:**_
The Registered Nurse Clinical Care Coordinator is responsible for evaluating,
coordinating, processing, screening, and documentation of patient entry into
the CHRISTUS Health System. The Registered Nurse 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. They 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 admissionplacement of every patient. This role
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.
• Provide after-hour and weekend support to the entire hospital from a Care
Management standpoint to include facilitating discharges after business hours
and responding to physician support needs and inquiries.
• Review all post-surgical patients who are placed in a bed to confirm
appropriate patient classadmission status and work with physicians to correct
patient class when errors are identified to maximize hospital reimbursement
and resource utilization.
• Responsible for 247 ongoing management of patients in Observation status to
include repeated review of clinical and opportunities for conversion to
inpatient status.
• Works closely to coordinate and collaborate with the ED Case Manager
regarding patient class, discharge planning from ED, and avoidance of
readmissions.
• Ensures the details of incoming communications from payors are entered into
the medical record (certifications, authorizations) and escalated when
indicated (receipt of denials, deadline for clinical receipt, etc.).
_**Requirements:**_
**EducationSkills**
* Graduate of an accredited school of nursing is required.
**Experience**
* Minimum of two (2) years’ experience in Case Management andor Utilization Management is required.
**Licenses, Registrations, or Certifications**
* RN License in the state of employment required.
* BLS is required.
**_Work Schedule:_
**
11p-7a M-F
**_Work Type:_
**
Full Time
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Job Tags
Full time, Immediate start, Weekend work,