EDUCATION/QUALIFICATIONS:
Registered Nurse license in the State of Illinois.

EXPERIENCE:
Care Management/Utilization Review experience preferred.

SKILLS:
Strong organizational and multi-tasking skills needed.

ADDITIONAL:

• Bachelor of Science in Nursing (BSN) preferred.
• Electronic Health Record experience and insurance knowledge helpful.

At Fairfield Memorial Hospital, we seek highly skilled, compassionate employees to continue our healing mission: to positively influence the health of those we serve. Our team is committed to providing the best possible patient experience. FMH is also committed to providing our team members with an environment that allows them to do their best work while providing opportunities for ongoing professional development.

NATURE OF WORK:
The Nurse Nurse Care Coordinator facilities the coordination of services and care to transition patients through the continuum of care. The scope of the position spans from primary care to ED to Hospital pre-admission for inpatient status or Swing Bed to post discharge.

The Nurse Care Coordinator completes preadmission and admission utilization review assessments utilizing InterQual Level or Care criteria in collaboration with Practitioners to determine the appropriateness of the hospital level of care to ensure that documents responsible for enhancing the quality of clinical outcomes and patient satisfaction all while managing the cost of care.

The are responsible for communicating with patients, providers, and caregivers to ensure improved care transitions, enhancement in patient-practitioner communication in order to identify opportunities for care continuity, encouraging the patient’s self-management skills and understanding of the health care system, and empowering the patient to take an active role in their care plan. They'll plan effectively to meet the patient’s needs, manage length of stay, promote efficient utilization resources, and decrease readmissions.

The Nurse Care Coordinator plays an active role in sending clinical data to insurance providers on an outgoing basis as per the payer requests/requirements for approval of payment. Conducts current and retrospective appeals making sure that the process is timely and communicates the status with Revenue Cycle Team members. Collaborates with Precertification Specialists, Health Information Director, Business office Director and other key stakeholders to ensure peer to peer reviews are scheduled/completed timely by credentialing practitioners. Manages referrals to the Swing Bed Program to obtains prior authorization for services rendered in collaboration with the Precertification Specialist. Attends Multi-Disciplinary Meetings to develop and modify individualized discharge planning aspects.