RN - Care Coordinator - Labor Pool

Smithfield, Virginia
Opening in early 2026, Riverside Smithfield Hospital will bring high-quality healthcare closer to home for Isle of Wight County residents. Located on a beautifully landscaped 27-acre medical campus at 19339 Benn’s Grant Boulevard in Smithfield
, the new hospital will provide modern facilities and comprehensive medical services to meet the growing needs of the community.

The 200,000-square-foot, three-story facility will offer a range of essential healthcare services including an Emergency Department, Diagnostic Imaging Services, 38 Medical/Surgical beds, 12 Intensive Care Unit (ICU) beds and 4 Operating Rooms. Join our team and be a part of an exciting opportunity to shape the future of healthcare in Smithfield, delivering compassionate, patient-centered care in a state-of-the-art environment.

We anticipate start dates to begin Fall, 2025.

Works under the supervision of the Manager and the Director and is responsible for working in collaboration with the healthcare team to coordinate the care and service to patients across the continuum of care, promoting effective utilization and monitoring of healthcare resources and assuming a leadership role with the interdisciplinary team to achieve optimal quality, clinical, and resource outcomes. Works to provide a comprehensive range of services or clinical care associated with and in accordance with standards of excellence established by Riverside Health System and facility goals and strategic plans.

Utilizes national hospital-based ACMA Scope of Services and Standards of Practice as the foundation of Care Management.

• Demonstrates the ability to build trusting, collaborative relationships with staff, peers, physicians, and other disciplines/ancillary services. In addition, capable of completing the problem solving cycle from identification to problem resolution to maximize opportunity or minimize problem. Demonstrates behaviors that reflect “commitment to my co-worker”.
• Seeks to attain knowledge and competency that reflects best practice for improved outcomes of clinical practice, guidelines and measures promoting the mission, vision and values of RHS.
• Collaborates with physicians to ensure compliance with level of care assessments based on clinical needs and utilization criteria and issues relevant to noncoverage/possible denials. Provides screening and identification of patients requiring post-acute care, provides timely assessments, develops plans of care, utilizes sequencing of interventions for safe, timely, efficient, effective, equitable, and patient centered transitional planning. Documents all avoidable days causing delays in throughput.
• Assesses patient records on assigned unit for medical necessity of acute hospital stay and LOS assignment. Performs utilization review activities in accordance with Riverside Regional Medical Center’s Utilization Management Plan. Confers regularly with physician on plan of care or continued stay and physician documentation. Participates in daily interdisciplinary planning meetings and weekly outlier case reviews. Coordinates and communicates the discharge plans with team members, patients, and their support systems/families.
• Assesses patients and families to determine needs and available resources so that the needs of the individuals are met in the most cost effective way. Communicates with payors and community resources. Strives to continuously improve the quality, process and outcomes of patient care with consideration of social determinants of health.
• Performs appropriate and timely general discharge planning duties to include arranging home health care, durable medical equipment, referrals to the Medical SW and Medicare IM notification. Performs timely discharge planning interventions for all post-acute transitions of care utilizing the EMR and includes care management assessment, use of readmission screening tools, screening for social determinants of health, and documents Freedom of Choice, Estimated Discharge Date, Care Act compliance, and Discharge Disposition.
  
  EMR is used to document all assessments and discharge planning changes that occur and are visible to…