RN Admissions Coordinator - Utilization Management

About Carle Health

At Carle Health, we are committed to fostering a workplace where every team member feels valued, respected, and empowered. Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We operate eight award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. Our commitment to excellence is recognized through Magnet® designations held by Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center.

We are developing the next generation of healthcare professionals through the Carle Illinois College of Medicine, the world's first engineering-based medical school, and Methodist College. We offer opportunities in several communities throughout central Illinois with potential for growth and lifelong careers.

About the Role

This position serves as a vital liaison between the hospital, external payers, and the interdisciplinary team to ensure optimal patient care outcomes on a 24-hour basis. You will be accountable for the proactive coordination and timely transition of assigned patients to the most appropriate level of care along the continuum, specifically focusing on the Eureka Swing Bed program.

In this role, you will facilitate the coordination of patient care by conducting interdisciplinary rounds and discharge planning. Your day-to-day activities involve screening all referrals for Eureka Swing Bed admission, performing pre-authorization and concurrent utilization management (UM), and ensuring reimbursement for acute rehab and swing bed admissions. You will act as a bridge between the hospital and external payers, managing the functional and financial outcomes during acute illness requiring hospitalization.

You will utilize the five core components of case management—assessment, coordination, monitoring, implementation, and evaluation—to ensure patients receive proactive initial assessments, ongoing evaluations, and safe transitions from acute care to appropriate levels of care outside the hospital. This includes assisting in the identification of appropriate admission diagnoses, managing length of stay relative to the patient's CMG, and proactively investigating coverage for post-hospital needs.

Work Environment

This role operates on a Monday through Friday schedule. The position requires on-site presence at Eureka, with 2 to 3 afternoons per week on-site at BroMenn, pending census and operational needs.

Equal Opportunity Employer

Carle Health is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, or basis of disability. We participate in E-Verify and are dedicated to maintaining a diverse and inclusive workforce.