"RN Coordinator (Admission Screening) - Case Management - Full Time 8 Hour Days (Non-Exempt) (Non-Union)"

The RN Admission Screening Coordinator provides oversight of pre-admission evidence-based criteria evaluations of non-transfer bed requests through identification of bed requests for non-transfer patients, review of established evidenced-based criteria, and adherence to established escalation processes to better ensure appropriate and timely reimbursement of these services rendered.

Essential Duties:

• Collaboration and communication with key stakeholders including: providers/managers/staff at clinics and hospitals ETC, Capacity Management, House Supervisors, hospital financial counselors, Utilization Management staff and Case Managers, Physician Advisors, and payers.
• Robust collaboration with hospital financial counselors, Capacity Management, and House Supervisor regarding bed requests for non-transfer patients.
• Evaluation of established evidence-based criteria for direct hospital admissions including, but not limited to: proposed admission status; status of authorization obtained by clinic staff and / or hospital financial counselors; appropriate level of care at admission.
• Implementation of escalation processes, including communication with provider and consultation with Physician Advisor when criteria are not met and/or proposed admission status is incorrect, and the physician does not agree with RN Surgery Screening Coordinator determination.
• Facilitation of scheduling of Peer-to-Peer meetings when payer denial received.
• Documentation of evaluations, including escalations and outcomes, in the Electronic Medical Record (EMR) in a timely manner and viewable by key stakeholders such as Case Managers, Physician Advisors, Patient Access, hospital financial counselors, and Claims.
• Post-admission validation of status ordered to confirm it is in accordance with established CMS and hospital guidelines including Medicares Two Midnight Rule.
• Collection of admission screening evaluation data for reporting, tracking, and trending of identified quality improvement opportunities in department processes, provider practices, and payer determinations.
• Participation in department Inter-Rater Reliability process.
• Maintains competencies for hospital, age specific and job specific standards of care; follows hospital procedures for accurate and timely processing of charges.
• Represents the department in a positive and professional manner.
• Supports orientation of new staff.
• Supports hospital and departmental protocols, workflows, policies, procedures, standards, and competencies for clinical role.
• Supports the mission, vision, and values of the organization.
• Performs other duties as requested/assigned.

Required Qualifications:

• Bachelors Degree Nursing Degree from an accredited school of nursing
• 3 years Experience as a Registered Nurse
• 2 years Utilization Review and Case Management experience in an acute hospital setting
• Experience with InterQual evidence-based criteria.
• Demonstrates ability to utilize effective and appropriate oral and written communication skills.
• Demonstrates ability to effectively work with physicians, staff, patients, and payers.
• Commitment to excellence inpatient care and customer service

Preferred Qualifications:

• Certified Case Manager - CCM (CMSA) Nationally recognized certification such as CCM and/or ACM

Required Licenses/Certifications:

• Registered Nurse - RN (CA Board of Registered Nursing)
• Basic Life Support (BLS) Healthcare Provider from American Heart Association
• Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The hourly rate range for this position is $53.00 - $87.45. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidates work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.