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Job Title: Care Facilitator

Department: Case Management

Hours Per Week: Per Diem

Schedule: 8-hour variable shifts, occasional weekends

SUMMARY: Comprehensively plans with the health care team to ensure patient needs are met and care delivery is coordinated across the continuum. Identifies and works to eliminate/minimize system variation and service delivery barriers that prevent achievement of optimal patient outcomes in the expected time frame and with most efficient utilization of resources. Carries out activities related to utilization management, discharge planning, care coordination and referral to other levels of care. Performs as an integral part of the interdisciplinary team promoting interdisciplinary collaboration and champions service excellence. Facilitates assignment of level of care, considers payer requirements and responds accordingly to avoid adverse financial consequence to patient and hospital. Provide superior customer service by modeling the Brand Promise and Core Values.RESPONSIBILITIES:

+ Conducts clinical reviews utilizing objective criteria (Interqual) to assign patient to the appropriate level of care; identifies clinical resources required to achieve optimal patient outcomes and appropriate reimbursement for the hospital.

+ Documents level of care and medical necessity in the Care Management Data base to support the clinical review process.

+ Concurrently monitors resources utilization, performing continued stay reviews and assists with managing the length of stay of patients across the continuum.

+ Appropriately identifies and refers cases to the Review Physician Advisor to validate level of care based on medical necessity to support timely progress of patient along the continuum.

+ Functions as a resource to health care team for payor requirements, ensuring optimal use of patient health care benefits.

+ Fosters relationships with payors and facilitates communication between hospital and payor as appropriate.

+ Concurrently communicates clinical information to payors; severity of illness, intensity of service and plan of care.

+ Performs retrospective reviews on insurance denials and assists in appeal process.

+ Participates in daily Huddles, providing ongoing communication to the Charge Nurse and Nurse Manager to address complex clinical issues, system barriers, and patient/family issues, concerns.

+ Works with Care Management Leadership to identify problems, recommend solutions and work toward resolution.

+ Utilizes data, trends and reports to proactively identify opportunities to improve processes and practice.

REQUIRED QUALIFICATIONS:Required Degree

+ Associates degree from an accredited School of Nursing required

Required Certification/Licensure

+ Licensed in New York State as a Registered Nurse

Required Years of Experience

+ For hires after 10/28/2024, 3 years acute hospital care experience required. If, hired prior to 10/28/2024, 3 years acute hospital care experience not required.

PREFERRED QUALIFICATIONS:

+ Case Management or Utilization Management experience preferred.

+ Bachelor’s Degree preferred

EDUCATION:

LICENSES / CERTIFICATIONS:

BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - New York State Education Department (NYSED)

PHYSICAL REQUIREMENTS:

M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$33.50 - $43.50

CITY:

Potsdam

POSTAL CODE:

13676

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity/Affirmative Action Employer. Minority/Female/Disability/Veterans by a prospective employee and/or employee’s Physician or delegate will be considered for accommodations.