RN- Admissions Coordinator/ Utilization Management

Company: Carle Health
Location: Normal
Posted on: May 15, 2025

Job Description:

Overview

Assures appropriate admission decisions are made and facilitates the coordination of the patients' care in collaboration with interdisciplinary team to assure optimal patient care outcomes on a 24 hour basis. Accountable for the proactive coordination and timely transition of assigned patients to the most appropriate level of care along the continuum. Screens all referrals for Eureka Swing bed for admission, performs Preauthorization and Concurrent UM for Carle BroMenn Medical Center Acute Rehab Unit and Carle Eureka swing bed patients. Is responsible for being a liaison between the hospital and external payers to insure reimbursement for acute rehab and eureka swing bed admissions.
Qualifications

Certifications: National Nursing Certification within 1 year - Varies; Licensed Registered Professional Nurse (RN) - Additional State - Varies; Basic Life Support (BLS) within 30 days - American Heart Association (AHA), Education: Bachelor's Degree: Nursing, Work Experience: Nursing > 2yr Inpatient or Case Management

Responsibilities

Collaborates with charge nurse daily to review all available beds, pending discharges, and isolation rooms to accurately coordinate admissions to the unit and ensure medical needs and safety issues are addressed.Communicates with patients and their families regarding eligibility for admission.Receives and tracks referral information, monitoring efficient accomplishments of referral process and overseeing distribution of referrals to physician. For referrals from outside Carle BroMenn Medical Center, obtains and reviews all necessary clinical and financial information, performs onsite clinical assessments if necessary to determine appropriate level of care, discusses assessment information and patient eligibility with physician.Obtains patient financial and insurance information as necessary and obtains approval from payors for admission as needed. Completes pre-certification/certification process if required. Obtains Medicare consents upon admission and discharge. Collaborates with the Rehab case manager in making recommendations for admission to the inpatient rehabilitation program, in accordance with Medicare guidelines and hospital programmatic considerations and guides decisions/suggests alternative rehabilitation services when the inpatient level of care is not appropriate.Assist with appeal process and review/evaluate denial letters.Completes concurrent reviews for all Swing bed and Acute rehab patients to ensure reimbursement for patient stay. Documents communication with payers in appropriate EMR location and within UM platform.Assists with UM needs and denial management as needed for acute inpatient at BroMenn or Eureka.Monitors key admission information as directed, including but not limited to, a referral log to track: referral trends, perception of referral sources of the rehab program and services, changes in referral patterns, changes within the identified market, internal and external challenges to the program and areas for improvement.Maintains a current knowledge of all Medicare, state and local regulations and guidelines concerning inpatient rehabilitation. Monitors utilization and keeps clinical team apprised of length of stay relative to the patient's CMG.Assists in identifying appropriate admission diagnoses and co-morbidities of the potential patients. Completes the preadmission information and ensures the physician receives necessary medical information for review and discussion of eligibility for swing bed admission. Assists in the identification and generation of management reports including clinical and financial performance outcomes.Maintains unit and hospital-based competencies.Participates in marketing, communication, strategic planning and policy development with other team members and the director.Works to ensure unit meets national and regional benchmarks and CMS requirements Provides support to IRF Case Manager and works as liaison to ensure authorization and concurrent review standards are met Provides oversight to the referral and admission process for Eureka Swing bed program.
About Us

Find it here.

Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health.

Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet - designations, the nation's highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance---. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. - For more information: human.resources@carle.com.

Compensation and Benefits

The compensation range for this position is $31.03per hour - $53.37per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate's experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.

Keywords: Carle Health, DeKalb , RN- Admissions Coordinator/ Utilization Management, Healthcare , Normal, Illinois