CCS Nurse Coordinator/Preadmission Review:
The CCS Nurse Coordinator/Preadmission Review role reviews all scheduled inpatient medical, surgical, and ambulatory admissions prior to admission to ensure appropriate level of care status in order to promote effective and efficient use of hospital resources and to ensure safe, quality patient care at the most appropriate level of care.
For each case scheduled, The CCS Nurse Coordinator reviews each surgical case entry and corresponding prescriber orders to ensure that the planned procedure is scheduled at the most appropriate level of care and that the prescriber orders are aligned with the level of care. Additional, insurance authorization is reviewed to ensure consistency with the level of care. The CCS Nurse Coordinator will intervene, as necessary, with the Physician Office and/or the Auth/Cert Team, when ‘mismatches’ are identified with procedure level of care, prescriber orders, and/or precertification.
The CCS Nurse Coordinator also participates in the Urgent Admission/Transfer Program during their assigned shift as well as participates in the on-call hours. The Urgent Admission/Transfer Team Member coordinates the process of urgent admissions or transfers to ensure that all patients will receive care in the most appropriate setting and access to all services to ensure safe and optimal care.
The successful candidate must be a NYS Licensed RN with solid Utilization Management and/or Managed Care experience. Strong interpersonal skills, proficiency in PC and database management and excellent communication skills are essential. The ability to demonstrate a real understanding of internal mechanisms for hospital care/clinical programs is crucial. Bachelor’s Degree required – UM/CM certification highly desirable.