Care Coordinator, Utilization Mgmt F/T Day

Role Details

Care Coordinator, Utilization Mgmt F/T Day

BAYSHORE MEDICAL CENTER Holmdel Requisition #2023-127646 ShiftDay StatusFull Time with Benefits Weekend WorkWeekends as Needed HolidaysAs Needed On CallNo On-Call Required Shift HoursDay Address727 North Beers Street, Holmdel, 07733

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Overview

How have you impacted someone's life today? At Hackensack Meridian Health our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career, all within New Jersey's premier healthcare system.

Responsibilities

The Care 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 patients 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.

• 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.

Qualifications

• Current NJ RN license

• BSN strongly preferred, required in 5 years

• 3-5 years acute care experience preferred

• Certification in Case Management or eligibility in 1 year

• AHA BLS/CPR certification

• Knowledge of Milliman Care Guidelines or Interqual preferred

• Excellent written, verbal and telephonic communication skills

Our Network

Hackensack MeridianHealth(HMH) is a Mandatory COVID-19 and 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.

Apply (https://nursing-hackensackmeridianhealth.icims.com/jobs/127646/login)

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Hackensack Meridian Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.