Norton County Hospital has a career opportunity for a Care Coordinator/Utilization Review. Applicants must be an LPN or RN licensed in Kansas and have strong communication, organization, and computer skills. The Case Coordinator is responsible for the overall direction and operation of the Swing Bed Program, Discharge Planning and Utilization Review in accordance with the Hospital policies and procedures. Applicants must be able to work effectively within all levels of the organization.

Primary responsibilities include but are not limited to the following:

Care Coordination:

• Assesses and evaluates patients to ensure progress towards desired outcomes.
• Responds to patient and family needs.
• Coordinates with Physicians and Interdisciplinary Care Team on patients’ progress and discharge needs. 
• Performs Utilization Review to ensure patient appropriateness of care and medical necessity.
• Documents all care coordination services, Interdisciplinary Team meetings, patient contacts, interventions, and outcomes in a complete, accurate, and timely manner to ensure continuity of care and regulatory compliance.
• Maintains and distributes admission folders to all inpatients and reviews admission information with the patient.
• Reviews all Medicare, Medicaid, BCBS, self-pay, and commercial insurance admissions through utilization of the InterQual system.
• Performs insurance prior authorization on admission, continued stay, and VA notification
• Reviews ER log and completes 72-hour notification for VA patients
• Performs admission review within the allotted admission time frame based on the severity of illness and service provided; meets with the Attending Provider to discuss a plan of care as necessary.
• Reviews and analyzes clinical documentation to ensure accuracy, completeness, and compliance with regulatory requirements.
• Monitors and manages the continued stay review daily, based on severity of illness and service provided; provides documentation to support the patient’s stay; contacts the Attending Provider when discharge criterion or orders are not met or are not present to establish plans for the patient.
• Prepares and delivers the notification of terminated benefits in accordance with applicable standards and rules for each payment source. 
• Facilitates the transition of patients between different levels of care as needed.
• Participates in quality improvement initiatives to enhance the efficiency and effectiveness of healthcare services. Provides feedback and recommendations for process improvement.

Swing Bed:

• Proactively educates pre-operative patients about Skilled Care services available at NCH following their surgery.
• When accepting patients for Skilled Care, verify active insurance plan coverage for skilled care services.
• Checks secondary insurance and performs prior authorization if needed.
• Ensures bed availability.
• Review medication list with Pharmacy Nurse to ensure NCH has the necessary medication for the patient.
• Host Interdisciplinary Team Meetings on a weekly basis for Skilled Swing Bed patients and monthly Interdisciplinary Team Meetings for Intermediate Swing Bed patients.
• Communicates with the patient and their families/caregivers regarding Interdisciplinary Team Meetings and discharge planning.

Discharge Planning:

• Meets with every patient on admission or strives to within twenty-four (24) hours unless admission falls on a weekend or holiday.
• Provide information to patients and their families concerning available support agencies and financial assistance programs
• Assesses and documents patient discharge planning needs in the EHR, identifies barriers to discharge, and develops and coordinates an appropriate discharge plan in collaboration with the patient, family, provider, and interdisciplinary team.
• Organizes and sets up home health, nursing home placement, DME, Care Assessments as needed.

Qualifications:

• Graduate of an accredited school of Nursing.
• Practical Nurse or Registered Nurse Licensure.
• Knowledge and training in areas of Skilled Swing Bed Program, Discharge Planning and Utilization Review preferred.
• Social Services Designee and Activities Director certification preferred.

NCH offers competitive salary and comprehensive benefit package including PTO (paid time off), health insurance, HSA matching contributions with high-deductible health plans, several supplemental insurances, KPERS retirement, life insurance, and disability, and additional voluntary retirement options.

Apply online on our Careers page at Employment Opportunities – www.ntcohosp.com

Applications can also be picked up at the Hospital Admissions Desk or requested by email from shempler@ntcohosp.com.  Please return resume or application to Shannan Hempler, Human Resources, Norton County Hospital, P.O. Box 250, Norton, Kansas 67654 or emailed to shempler@ntcohosp.com.  EOE.