RN Care Coordinator – Corewell Health
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About the Department
Coordinates care for groups of patients with focus on disease management, resource utilization, access, discharge planning, quality, and service efficiency across the continuum. This interventional role maintains a patient‑centered focus.
Scope of Work
Under general direction, integrates cost, quality, and utilization to facilitate admission, continued stay, and discharge of the patient. Reviews appropriateness of admission or continued stay based on medical necessity. The overall goal is to enhance quality of patient care and engagement, promote continuity and cost effectiveness through utilization management, care coordination, discharge planning, and appropriate care transitions. Holds accountability for care coordination and discharge planning of all hospitalized patients.
Responsibilities
Identify patients that need care management services (e.g., utilization review, care coordination, and/or discharge/transition planning).
Manage a case load of patients, facilitating utilization management and/or care coordination during the patient’s stay, planning and expediting safe and effective discharge and transition to the appropriate level of care.
Use critical thinking and effective judgment to determine alternative courses of care; judiciously use tools designed to expedite care while being cost‑effective.
Participate in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization; collaborate on processes to provide effective transition for patients utilizing hospital outpatient, observation, or inpatient services.
Review cases for medical necessity, using InterQual and/or other UR/UM Committee‑approved screening criteria when appropriate; collaborate with revenue cycle, clinical appeals staff, physicians, and payers to obtain authorization for care and appropriate reimbursement.
Routinely communicate with payers, patients/family caregivers, physicians, interdisciplinary team, post‑acute and community‑based care providers to facilitate coordination of care and a seamless transition from hospital to the appropriate level of care.
Seek out information and resources to apply creative problem solving for complex discharge/transition planning, quality of care, and utilization management issues; provide notification and communication to patients/families regarding coverage for hospital and post‑acute services in accordance with CMS regulations.
Document utilization reviews, utilization management actions, care management assessments, care plans, discharge plans, and interventions as per policies and regulatory requirements.
Collaborate with other departments to define areas of hospital inefficiency and participate in improvement projects.
Qualifications
Bachelor’s degree, Graduate of an accredited school of nursing.
Preferred: Non‑BSN RN actively pursuing a BSN within 2 years of hire.
Required: Minimum 2 years of acute care experience.
Preferred: 3–5 years of experience in care management, utilization review, home care, and/or discharge planning.
Registered Nurse (RN) – State of Michigan required.
Benefits
Comprehensive benefits package to meet financial, health, and work/life balance goals.
On‑demand pay program powered by Payactiv.
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Optional identity theft protection, home and auto insurance, pet insurance.
Traditional and Roth retirement options with service contribution and match savings.
Eligibility for benefits depends on employment type and status.
EEO Statement
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 class. All applicants will be treated fairly and without discrimination or retaliation. We also provide reasonable accommodations for qualified individuals with disabilities or sincere religious beliefs.