We are recruiting for a RN Care Coordinator - Hospital Care Management to join our team!
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Hospital Care Mgmt
Under general supervision, the RN Care Coordinator is responsible for facilitating and coordinating the care delivered to an assigned group of patients through multidisciplinary and patient/family collaboration to ensure quality and cost effective outcomes are delivered within appropriate care coordination parameters. Coordination involves assessment, planning, support, and evaluation of patient care and related outcomes. Activities to be performed are facilitation of appropriate status and level of care, screening for high risk and transition of care needs, interviews with patient/family, progression of care facilitation with the healthcare team, performing insurance reviews and ensuring compliance with all state, federal and third party payors.
Medical Necessity: Conducts medical necessity reviews on all inpatient admissions, transfers and continued stay patients using approved medical necessity criteria daily. Works with the Clinical Documentation Improvement Specialists and physicians to identify opportunities to improve the accuracy of the documentation. Uses the criteria software application to document results of criteria application according to the documentation policy. Initiates Physician Advisor referrals for any cases not meeting criteria for the level of care Ensures compliance with all state, federal and payor medical necessity and certification requirements (35%)
Utilization Review for Insurance Companies: Documents clinical information as required for insurance company certification according to required payor timeframe standards. Works collaboratively with the Clerical Support Staff to ensure all insurance reviews are received by the insurance company and a disposition response is received. Documents all insurance certification activities in the assigned locations according to the department documentation standards. (35%)
Compliance: Ensures compliance with all applicable state and federal regulatory requirements as well as the insurance company rules such as Patient Choice, Important Message from Medicare #2, Condition Code 44, insurance certification processes, etc. Maintains compliance with established hospital policies, procedures, objectives, safety, environmental and infection control guidelines. Protects Patient Rights as they pertain to the ethical and legal issues of confidentiality during the case management process. (30%)
Bachelor's Degree Completion of a nursing education program that satisfied the licensing requirements of the Colorado Sate Board of Nursing for Registered Nurses Required and
1-3 years 3 years of clinical inpatient experience Required
Active Registered Nurse (RN) License in the Sate of Colorado or a participating compact state. Basic Life Support (BLS/CPR) from American Heart Association (Required)
Knowledge, Skills and Abilities:
Knowledge and understanding of case management/coordination of care principles, programs, and processes in either a hospital or outpatient healthcare environment required.
Effective problem-solving skills, including the ability to analyze complex situations, draw conclusions and implement actions appropriately and efficiently.
Evidence of leadership, creativity, integrity and initiative required.
Ability to work effectively in a team environment.
Experience with windows-based computer programs and ability to use computer for data analysis and data display required; must be able to type 35 words/minute.
EPIC experience a plus.
$84,600.00 - $126,900.00 / yr
Shared leadership and advancement opportunity
Immediate retirement plan matching
Professional clinical advancement program
Participation in evidence-based projects
Public Service Loan Forgiveness (PSLF) eligible employer
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation's leaders in medicine.Denver Health is an Equal Opportunity Employer At Denver Health we pride ourselves on our commitment to diversity. Equal opportunity is a fundamental principle of Denver Health. As an equal opportunity employer, Denver Health is committed to recruit, hire, promote and administer all human resource actions in a non-discriminatory manner. Denver Health is committed to providing equal opportunities in all business practices and to all persons regardless of age, race, color, national origin, genetic information, religion, sex, pregnancy, disab...ility, sexual orientation, gender identity, gender expression, marital status or veteran status (collectively “protected status”). Denver Health strives to maintain a work environment that is free from unlawful harassment and discrimination and will not tolerate any such conduct by employees or directed at employees within the scope of their employment. Read the full Human Resources Employee Principles and Practices policy.