RN Admissions Coordinator - Utilization Management

Carle Health

Eureka, IL

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JOB DETAILS

SALARY

$34.01–$58.50 Per Hour

SKILLS

Acute Care, Basic Life Support (BLS), Benchmarking, Case Management, Clinical Assessment, Clinical Information, Clinical Validation, Content Management Systems (CMS), Discharge Plans, Distribution Management, Documentation Plan, Electronic Medical Records, Financial Regulations, Healthcare Providers, Homeland Security, Hospital, Identify Issues, Insurance, Java Swing, Marketing Communications Strategy, Medical Records, Medicare, Medicine, Needs Assessment, Nursing, Nursing Credentials, Organizational Skills, Patient Assessment, Patient Care, Patient Care Authorizations, Patient Care Denials, Policy Development, Problem Solving Skills, Quality of Care, Registered Nurse (RN), Reimbursement, Risk Management, Social Security Administration, State Laws and Regulations, Strategic Planning, Time Management, Treatment Plan

LOCATION

Eureka, IL

POSTED

5 days ago

Overview

(Monday through Friday on site at Eureka, 2 to 3 afternoons on site at BroMenn pending census and need. )

(Nursing RN>2yrs Case management Preferred)

Assures appropriate admission decisions are made and facilitates the coordination of the patients' care in collaboration with interdisciplinary team to assure optimal patient care outcomes on a 24 hour basis. Accountable for the proactive coordination and timely transition of assigned patients to the most appropriate level of care along the continuum. Screens all referrals for Eureka Swing bed for admission and performs Preauthorization and Concurrent UM for Carle Eureka swing bed patients. Is responsible for being a liaison between the hospital and external payers to ensure reimbursement for acute rehab and Eureka swing bed admissions. Responsible for the oversight, coordination, and management of the functional and financial outcomes during acute illness requiring hospitalization for patients of Carle Health. Ensures patients receive proactive initial assessment of needs, ongoing evaluations, and initiation of discharge planning while facilitating a safe and timely transition from the acute care/hospital setting to an appropriate level of care outside the hospital. Additionally, responsible for conducting interdisciplinary rounds and discharge planning for Eureka Swing Bed patients. Utilizes the five components of case management: assessment, coordination, monitoring, implementation, and evaluation.

Qualifications

Certifications: National Nursing Certification within 3 years - Varies; Basic Life Support (BLS) within 30 days - American Heart Association (AHA); Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR), Education: Bachelor's Degree: Nursing, Work Experience: Nursing RN>2yrs Case management Preferred

Responsibilities

Collaborates with charge nurse daily to review all available beds, pending discharges, and isolation rooms to accurately coordinate admissions to the unit and ensure medical needs and safety issues are addressed.Communicates with patients and their families regarding eligibility for admission.Receives and tracks referral information, monitoring efficient accomplishments of referral process and overseeing distribution of referrals to physician. For referrals from outside Carle BroMenn Medical Center, obtains and reviews all necessary clinical and financial information, performs onsite clinical assessments if necessary to determine appropriate level of care, discusses assessment information and patient eligibility with physician.Obtains patient financial and insurance information as necessary and obtains approval from payors for admission as needed. Completes pre-certification/certification process if required. Obtains Medicare consents upon admission and discharge.Assist with appeal process and review denial letters.Completes concurrent reviews for all Swing bed patients to ensure reimbursement for patient stay. Documents communication with payers in appropriate EMR location and within UM platform.Monitors key admission information as directed, including but not limited to, a referral log to track: referral trends, perception of referral sources of the rehab program and services, changes in referral patterns, changes within the identified market, internal and external challenges to the program and areas for improvement.Maintains a current knowledge of all Medicare, state and local regulations and guidelines concerning inpatient rehabilitation. Monitors utilization and keeps clinical team apprised of length of stay relative to the patient’s CMG.Assists in identifying appropriate admission diagnoses and co-morbidities of the potential patients. Completes the preadmission information and ensures the physician receives necessary medical information for review and discussion of eligibility for swing bed admission. Assists in the identification and generation of management reports including clinical and financial performance outcomes.Maintains unit and hospital-based competencies.Participates in marketing, communication, strategic planning and policy development with other team members and the director.Acts a liasion working with patient/family and physician to determine next level of care and manage LOSCoordinates transitions to appropriate levels of care (ie acute to subacute, swing bed to home, acute to home etc) collaborating with physicians, consultants, internal and external referrals to facilitate appropriate level of care to meet patient goals and outcomes. Documents plan of care and utilizaiton issues in appropriate locations on all assigned patients.Acts a liaison working with patient/family and physician to determine next level of care and manage LOS to ensure progression towards desired patient outcomes while manageing risk for readmission and length of stay.Proactively investigates coverage for post hospital needs and presents options to the patient/family and provider. Provides oversight of the acute setting plan of care to ensure coordination and completion of services to meet post hospitalization needs.Works to ensure unit meets national and regional benchmarks and CMS requirements Works as liaison to ensure authorization and concurrent review standards are met Provides oversight to the referral and admission process for Eureka Swing bed program. Performs case management activities of assessment, coordination, planning, monitoring, implementation and evaluation for Eureka Swing and Acute care patients. Interacts with patients, caregivers, and families to assess plan of care, arrange services, monitor and provide support and education. As well as facilitating referrals to assist in discharge planning activies.
About Us

Find it here.

Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.

Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.

Compensation and Benefits

The compensation range for this position is $34.01per hour - $58.5per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.

About the Company

Carle Health

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