Job Description

Job Title: Care Facilitator

Department: Case Management

Location: Canton-Potsdam Hospital

Hours Per Week: 40 scheduled weekly hours

Schedule: 8:00 am-4:30 pm,1 weekend every 4 weeks, travel to other sites expected

SUMMARY: Comprehensively plans with the health care team to ensure patient needs are met and care delivery is coordinated across the continuum. Identifies and works to eliminate/minimize system variation and service delivery barriers that prevent achievement of optimal patient outcomes in the expected time frame and with most efficient utilization of resources. Carries out activities related to utilization management, discharge planning, care coordination and referral to other levels of care. Performs as an integral part of the interdisciplinary team promoting interdisciplinary collaboration and champions service excellence. Facilitates assignment of level of care, considers payer requirements and responds accordingly to avoid adverse financial consequence to patient and hospital. Provide superior customer service by modeling the Brand Promise and Core Values.

RESPONSIBILITIES:

• Conducts clinical reviews utilizing objective criteria (Interqual) to assign patient to the appropriate level of care; identifies clinical resources required to achieve optimal patient outcomes and appropriate reimbursement for the hospital.
• Documents level of care and medical necessity in the Care Management Data base to support the clinical review process.
• Concurrently monitors resources utilization, performing continued stay reviews and assists with managing the length of stay of patients across the continuum.
• Appropriately identifies and refers cases to the Review Physician Advisor to validate level of care based on medical necessity to support timely progress of patient along the continuum.
• Functions as a resource to health care team for payor requirements, ensuring optimal use of patient health care benefits.
• Fosters relationships with payors and facilitates communication between hospital and payor as appropriate.
• Concurrently communicates clinical information to payors; severity of illness, intensity of service and plan of care.
• Performs retrospective reviews on insurance denials and assists in appeal process.
• Participates in daily huddles, providing ongoing communication to the Charge Nurse and Nurse Manager to address complex clinical issues, system barriers, and patient/family issues, concerns.
• Works with Care Management Leadership to identify problems, recommend solutions and work toward resolution.
• Utilizes data, trends and reports to proactively identify opportunities to improve processes and practice.

REQUIRED QUALIFICATIONS:

• Diploma from an accredited nursing school program or Associate's Degree required.
• For hires after 10/28/2024, 3 years acute hospital care experience required. If, hired prior to 10/28/2024 3 years acute hospital care experience not required.
• Licensed in New York State as a Registered Nurse.

PREFERRED QUALIFICATIONS:

• Case Management or Utilization Management experience preferred.
• Bachelor’s Degree preferred.

EDUCATION:

LICENSES / CERTIFICATIONS:

BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - NYS Office of Professions

PHYSICAL REQUIREMENTS:

Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67–100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver’s license.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$70,000.00 - $95,000.00

CITY:

Potsdam

POSTAL CODE:

13676

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.