Care Coordinator, Utilization Management
Company: Hackensack Meridian Health
Location: Hackensack
Posted on: April 28, 2024
Job Description:
Overview
Our team members are the heart of what makes us better. At
Hackensack Meridian Health we help our patients live better,
healthier lives - and we help one another to succeed. With a
culture rooted in connection and collaboration, our employees are
team members. Here, competitive benefits are just the beginning.
It's also about how we support one another and how we show up for
our community. Together, we keep getting better - advancing our
mission to transform healthcare and serve as a leader of positive
change.The Case Management Care Coordinator, Utilization Management
is a member of the healthcare team and is responsible for
coordinating, communicating, and facilitating the clinical
progression of the patient's treatment. Accountable for a
designated patient caseload; the Care Coordinator, Utilization
Management plans effectively in order to manage length of stay,
promote efficient utilization of resources and ensure that care
meets evidence-based practice standards and regulatory/payor
requirements and follows the state of New Jersey regulations for
Nursing.
Responsibilities
A day in the life of a Case Management Care Coordinator,
Utilization Management at Hackensack Meridian Health includes:
- Follows departmental workflows for utilization review
activities including admission reviews, admission denials,
continued stay reviews, continued stay denials, termination of
benefits, communication of information to insurance company,
billing certifications, concurrent managed care denial appeals and
retrospective medical record utilization reviews.
- Obtains and evaluates medical records for inpatient admissions
to determine if required documentation is present.
- Obtains appropriate records as required by payer agencies and
initiates physician advisor's review as necessary for unwarranted
admissions.
- Performs chart reviews for appropriateness of admission and
continued hospital stay applying appropriate clinical criteria.
Performs admission review within 24 hours or the first business
day.
- Refers cases not meeting criteria to the physician advisor or
designated vendor for determination and action.
- Participates actively on appropriate committees, workgroups,
and or meetings.
- Identifies and refers quality issues for review to the Quality
Management Program.
- Participates in multidisciplinary rounds, specific to assigned
units. Brings forth issues which impact discharge and length of
stay in a timely manner.
- Performs appropriate reassessments and evaluates progress
against care goals and the plan of care and revises plans, as
needed
- Collaborates with all members of the multidisciplinary team to
support length of stay reduction and observation management
goals.
- Provides appropriate CMS documents to the patient and
family/support person as per regulatory guidelines (ie., Important
Message 4 to 48 hours prior to discharge, appeal and HINN
notices)
- Maintains annual competencies and completes training and
continuing education in applicable platforms. (Epic, Xsolis Cortex,
Enterprise Analytics, Google Suites)
- Adheres to the Medical Centers Organization Competencies and
the Standard of Behavior.
- Other duties as assigned
Qualifications
Education, Knowledge, Skills and Abilities Required:
- BSN or BSN in progress and/or willing to acquire within 3 years
of hire or transfer into the position.
- Effective decision-making skills, demonstration of creativity
in problem-solving, and influential leadership skills.
- Excellent verbal, written and presentation skills
- Moderate to expert computer skills
- Familiar with hospital resources, community resources, and
utilization management Licenses and Certifications Required:
- NJ State Professional Registered Nurse License.
- AHA Basic Health Care Life Support HCP Certification.
- Care Management certification by a nationally recognized
organization within 1 year. If you feel that the above description
speaks directly to your strengths and capabilities, then please
apply today!
Our Network
Hackensack Meridian Health (HMH) is a Mandatory Influenza
Vaccination Facility
As a courtesy to assist you in your job search, we would like to
send your resume to other areas of our Hackensack Meridian Health
network who may have current openings that fit your skills and
experience.
Keywords: Hackensack Meridian Health, Yonkers , Care Coordinator, Utilization Management, Executive , Hackensack, New York
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