Website Virginia Commonwealth University HealthSystem
VCU Health System’s Utilization Review is seeking a full time RN Care Coordinator to function as a part of a multidisciplinary team, including physicians, social workers, discharge planning assistants and payers. Ensures that patient’s progress in the acute episode of care through post discharge is quality driven while being efficient, cost effective and safe. Will also be patient focused and outcome oriented.
Works with the attending and consulting physicians to facilitate effective and efficient transition through the process of hospitalization. Works collaboratively with all members of the multi-disciplinary team to ensure patient needs are met and care delivery is coordinated across the continuum, as well as appropriately reimbursed by payers as contracted, and that resources are efficiently and effectively utilized.
Seeks the expertise of social workers to resolve psychosocial patient care issues and to develop complex patient transition/discharge plans as needed. Interacts with patients, family members, healthcare professionals, and community and state agencies in this effort. Serves as an advanced clinical resource to the team.
Serves as a liaison between the hospital and community agencies or facilities for the exchange of clinical and referral information. The role is responsible for maintaining hospital compliance with the Quality Improvement Organization (QIO) series and CMS guidelines.
Utilizes medical necessity criteria as a tool to assess appropriateness of level and setting of care, assists in the denial and appeals process, assesses quality and identifies and reports potential risk management issues.
Responsible for participation in and completion of all patient safety initiatives appropriate to the position. The incumbent conducts all job responsibilities according to VCUHS’ Mission and Values. Responsible for establishing and maintaining a professional rapport with providers, patients/families, and internal customers.
Baccalaureate Degree in Nursing from an accredited School of Nursing
Licensed Registered Nurse in the State of Virginia or eligible
Minimum of three (3) years of nursing experience in an acute care setting
Masters Degree in Nursing or a healthcare related field from an accredited program
Current RN licensure in Virginia
Complete 15 Continuing Education Units per year
Academic healthcare experience
One (1) year of UM/Care Coordination experience
Clinical experience with specialty patient population