RN Care Coordinator

Scope of Work

Under general direction, integrates cost, quality, and utilization to facilitate admission, continued stay, and discharge of patients. Reviews and evaluates appropriateness of admission or continued stay based on medical necessity. The overall goal is to enhance patient care quality and engagement, promote continuity, and ensure cost‑effectiveness through utilization management, care coordination, discharge planning, and appropriate care transitions. Has accountability for 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 planning).
• Manages a caseload of patients, facilitating utilization management and care coordination during the stay, planning and expediting safe and effective discharge and transition to the appropriate level of care and setting after hospitalization.
• Uses critical thinking and judgment to determine alternative courses of care; judiciously uses tools designed to expedite care while being cost effective; participates in readmission initiatives and strategies to maximize patient flow and resource utilization.
• May review cases for medical necessity using Inter Qual or other UR/UM Committee‑approved screening criteria; collaborates with revenue cycle, appeals staff, physicians, and payers to obtain authorization and appropriate reimbursement.
• Communicates routinely with payers, patients/family caregivers, physicians, the interdisciplinary team, post‑acute and community‑based care providers to facilitate coordination and ensure a seamless transition from hospital to appropriate level of care.
• Seeks 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, management actions, care management assessments, care plans, discharge plans, and interventions per policies, procedures, and regulatory, contractual, and legal requirements.
• Works collaboratively with other departments to identify inefficiencies and participate in improvement projects.

• Required:
  
  Bachelor’s Degree;
  Graduate of an accredited nursing school.
• Consider non‑BSN RN if actively pursuing a Bachelors degree in nursing with completion within two years of hire.
• Required:
  
  Minimum two years of relevant experience in the acute care setting.
• Preferred:
  Three to five years of experience in care management, utilization review, home care, and/or discharge planning.
• Required:
  
  Registered Nurse (RN) – State of Michigan license upon hire.
• Preferred: BLS certification (American Heart Association or American Red Cross). If preferred by both, choose the specific certification that applies.
  • Case Manager, Certified (CCM) – CCMC Commission for Case Manager Certification upon hire (preferred).

• Comprehensive benefits package to meet financial, health, and work/life balance goals.
• On‑demand pay program powered by Payactiv.
• Discounts directory for restaurants, phone plans, spas, and more.
• Optional identity theft protection, home and auto insurance.
• Traditional and Roth retirement options with employer contribution and match savings.
• Eligibility for benefits determined by employment type and status.

Primary

Location:

Royal Oak Hospital – 3601 W 13 Mile Rd, Royal Oak

Department:
Care Management – Royal Oak Hospital

Employment Type:

Full time

Shift: Day (United States of America)

Weekly Scheduled

Hours:

40

Hours of Work: 8:00 a.m. to 4:30 p.m.

Days Worked:
Monday to Friday

Weekend Frequency:
Variable weekends

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and the community. We require a drug‑free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirements if in an on‑site or hybrid workplace category.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

We are committed to supporting prospective team members who require reasonable accommodations to complete the application process, perform the essential functions of the job, or enjoy equal benefits and privileges of employment due to disability, pregnancy, or sincerely held religious belief.

You may request assistance in completing the application process by calling .