Overview

Care coordinators/case managers are patient advocates. Their job is to make sure patients are assessed in a timely way and that needs are properly addressed. They work with patients, families, and health care professionals to coordinate and transition a patient to the appropriate level of care they need. They conduct initial (and subsequent) "medical necessity assessments" for patients.

As a care coordinator, you will collaborate with physicians, nurses, members of multidisciplinary care teams, and post-acute care providers. You should be able to provide assessment and detailed documentation of a patient's condition, their care plan, and medical recommendations. You must keep up-to date on all current payor requirements to support clinical patient reviews. Your knowledge and experience will have an impact on key results (such as top decile performance) in length of stay, cost-efficient resource utilization, prevention of readmissions, and unnecessary emergency room visits.

Requirements

To become a care coordinator you must have:

• Bachelor of Science in Nursing (BSN) or advanced nursing degree.
• Minimum of 3 years clinical nursing experience in a specialty field.
• Current Georgia Registered Nurse (RN) license.
• Current American Heart Association Healthcare Provider BLS certification.

Preferred Reqirements
In addition, any of the following are highly encouraged when you are seeking a position in care coordination:

• Professional certification in accordance with case management requirements.
• Experience with disease management programs.
• Knowledge of Medicare, Medicaid, and other third party payors.
• Knowledge of InterQual and/or Milliman criteria.
• Prior case management, utilization review, or clinical documentation review experience.