Saint Peter's Healthcare System
  • New Brunswick, NJ, USA
  • Per-diem

The Care Coordination group at Saint Peter's is seeking a Registered Nurse to join their team. The Care Coordination Nurse performs admission and concurrent review of patients. Provides clinical information to payors. Initiates appropriate referrals to Physician Advisor. Active intervention as needed to reduce denials. Collaborates with other disciplines to implement a care plan. Coordinates home care plan and referrals for patient. Supports the collection of quality and risk management data.


As the Care Coordination Nurse, you will:

  • Identify appropriate medical information necessary to certify/refer cases on admission and on continued stay review
  • Perform assigned admission reviews within established time frame (within 24 working hours of admission) with concurrent daily reviews for managed care companies, and one to three days for concurrent review for other assigned payer categories as evidenced by no denials for lack of clinical information.
  • Ensure timely provision of clinical review information to payer as evidenced by no denials for lack of clinical information.
  • Initiate provision of review to payer independent of payer request unless there is lack of clarity regarding the product and to whom review should be provided.
  • Whenever possible, manage request for concurrent reconsiderations as evidenced by the "Overturn" of the initial denial decision.
  • Initiate collaboration with the Medical Staff by requesting additional clinical information and/or suggestions for documentation so as to obtain payer determination of "acute" for each inpatient day as evidenced by the Net Denial Rate.
  • Coordinate the interdisciplinary team and the development of the plan of care.
  • Formulate comprehensive, realistic and achievable home care plan as appropriate to the ages of the patients and to the developmental life cycle stage.

Requirements:

  • Registered nurse currently licensed to practice in the state of New Jersey.

  • Minimum of three (3) to five (5) years experience in acute care nursing. Experience should include assessment of a patient's diagnosis, prognosis, care needs and outcomes goals. The ability to analyze medical records including clinical and laboratory data and problem solving skills are required.

  • Excellent interpersonal and communication skills.

  • Must be willing to work on some weekend days and on some holiday days.

Saint Peter's Healthcare System
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