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RN Care Management Coordinator

Company: Zolon Tech
Location: Philadelphia
Posted on: December 6, 2017

Job Description:

Job DescriptionSkills : Active PA RN license, Driver LicenseJob Description :

  • Under the direction of a designated Care Management and Coordination Supervisor, performs telephonic or onsite review of hospital admissions, determining alternative settings when appropriate.
  • Works to add value to healthcare by encouraging efficient and high quality use of the healthcare delivery system.
  • Promotes timely and dynamic discharge planning to facilitate early discharge and refers cases to Case Management when indicated.
  • Efficiently collaborates with the hospital utilization review department, attending physicians and members/families as appropriate.Duties & Responsibilities :
    • Performs utilization management for inpatient admissions either onsite or telephonically.
    • Using the medical software criteria, establish the need for inpatient, continued stay and length of stay.
    • Directs the delivery of care to the most appropriate setting, while maintaining quality.
    • Contacts attending physicians regarding treatment plans/plan of care and clarifies medical need for inpatient stay or continued inpatient care
    • Identifies inpatient admissions no longer meeting criteria and refers care to plan Medical Directors for evaluation.
    • Presents cases to Medical Directors that do not meet established criteria and provides pertinent information regarding member's medical condition and the potential home care needs.
    • Performs early identification of hospitalized members to evaluate discharge planning needs.
    • Collaborates with hospital case management staff, physician and family to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting.
    • Identifies and refers cases for case management and disease management.
    • Identifies quality of care issues including delays in care. Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Supervisor when indicated.
    • Maintains the integrity of the system information by timely, accurate data entry. Utilization decisions are in compliance with state, federal and accreditation regulations.
    • Works to build relations with all providers and provides exceptional customer service.
    • Reports potential utilization issues or trends to designated supervisor and recommendations for improvement.
    • Participates in the process of educating providers on managed care.
    • Performs additional related duties as assigned.Education and experience:
      • Registered Nurses/BS preferred. Minimum of three (3) years of acute care clinical experience in a hospital or other health care setting.
      • Prior discharge planning and/or utilization management experience is desirable.
      • Driver's License and access to automobile required.Skills:
        • Exceptional communication skills on all levels.
        • Problem solving ability
        • Organized, demonstrated excellent team management skills
        • Team PlayerCompany DescriptionZolon Tech, Inc. (ZTI) is a fast-growing, 8(a) certified business providing Information Technology solutions and services to Federal and commercial clients. ZTI is CMMI Level 3, ITIL, and ISO 20000 certified and is a leader in the IT industry. Headquartered in Herndon- VA.

          Keywords: Zolon Tech, Philadelphia, RN Care Management Coordinator, Healthcare, Philadelphia, Pennsylvania

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