Care Management, Care Coordinator, Utilization Management

3 weeks ago

Holmdel, New Jersey, United States Hackensack Meridian Health Full time

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 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 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 Care 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).
  • Other duties and/or projects as assigned.
  • Adheres to HMH Organizational competencies and standards of behavior.

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.

Licenses and Certifications Preferred:

  • Certified Case Manager (CCM), Certified Clinical Medical Assistant (CCMA), or American Case Management Association (ACMA) certification strongly preferred.

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.

  • Nursing Care Coordinator

    2 days ago

    Holmdel, New Jersey, United States Complete Care at Bayshore, LLC Full time

    About the RoleWe are seeking a skilled Licensed Practical Nurse (LPN) to join our team at Complete Care at Bayshore, LLC. As a LPN, you will play a vital role in providing high-quality patient care and contributing to the success of our organization.ResponsibilitiesOversee day-to-day patient care, ensuring the highest level of comfort and well-being.Monitor...

  • Subacute Nurse

    3 days ago

    Holmdel, New Jersey, United States Complete Care at Bayshore, LLC Full time

    About Complete Care at Bayshore, LLCWe are a leading provider of high-quality healthcare services, dedicated to improving the lives of our residents and their families. Our team of compassionate professionals is committed to delivering exceptional care and support in a safe and nurturing environment.Subacute Nurse RoleWe are seeking a skilled and dedicated...

  • Licensed Practical Nurse

    3 days ago

    Holmdel, New Jersey, United States Complete Care at Bayshore, LLC Full time

    About Complete Care at Bayshore, LLCWe are a leading healthcare provider dedicated to delivering high-quality patient care and exceptional compassion. Our team is committed to creating a supportive and caring environment for our patients and employees alike.Job SummaryWe are seeking a skilled Licensed Practical Nurse (LPN) to join our team at Complete Care...

  • Licensed Practical Nurse

    7 days ago

    Holmdel, New Jersey, United States Complete Care at Bayshore, LLC Full time

    About UsComplete Care at Bayshore, LLC is a leading provider of high-quality healthcare services, dedicated to improving the lives of our patients and their families.Job SummaryWe are seeking a skilled and compassionate Licensed Practical Nurse (LPN) to join our team. As an LPN, you will play a vital role in delivering exceptional patient care and...

  • Regional Operations Director

    2 days ago

    Holmdel, New Jersey, United States PM Pediatric Care Full time

    About the RolePM Pediatric Care is seeking an experienced Regional Operations Director to lead a portfolio of 8-12 urgent care locations with a team of approximately 100 members. The successful candidate will be responsible for developing market growth strategies, driving business and clinical outcomes, and serving as a key member of the leadership team...

  • Regional Operations Director

    3 days ago

    Holmdel, New Jersey, United States PM Pediatric Care Full time

    About the RolePM Pediatric Care is seeking an experienced Regional Operations Director to lead a portfolio of 8-12 urgent care locations with a team of approximately 100 members. The successful candidate will be responsible for developing market growth strategies, driving business and clinical outcomes, and serving as a key member of the leadership team...

  • Assistant Nurse Manager

    1 month ago

    Holmdel, New Jersey, United States Hackensack Meridian Health Full time

    Overview Our team members are the heart of what makes us better. At Hackensack MeridianHealth we help our patients live better, healthier lives — and we help one another tosucceed. With a culture rooted in connection and collaboration, our employees areteam members. Here, competitive benefits are just the beginning. It's also about howwe support one...

  • LPN (Licensed Practical Nurse) - Home Health Care Professional

    5 days ago

    Holmdel, New Jersey, United States White Glove Community Care Full time

    Welcome to White Glove Community Care, Inc.We are a leading provider of home care services, seeking highly skilled LPN (Licensed Practical Nurse) professionals to join our team. As a home health care professional, you will have the opportunity to work on a variety of cases across New York and New Jersey, tailored to your preferences and availability.LPN...

  • Lead Fragrance Innovation Manager

    2 weeks ago

    Holmdel, New Jersey, United States International Flavors and Fragrances Full time

    Requisition ID: 502427 Position Overview: Are you eager to embrace a role that empowers you to make a significant impact and contribute to a greater cause? Do you aspire to enhance the lives of countless individuals globally? If you possess a fervor for fragrances and creativity, the position of Lead Fragrance Innovation Manager at International Flavors and...

  • Practical Nursing Specialist

    2 weeks ago

    Holmdel, New Jersey, United States Complete Care Full time

    JOIN OUR TEAM!Become a part of a dedicated group that is making a difference in healthcare.NOW HIRING:Practical Nursing Specialist (LPN)Shift: 11-7About Us:At Complete Care, we are a cornerstone of the community, committed to enhancing the lives of those we serve through exceptional healthcare and heartfelt compassion.Why Choose a Career with Us?As a...

  • Practical Nursing Specialist

    2 weeks ago

    Holmdel, New Jersey, United States Complete Care Full time

    Join Our Team!We are excited to announce that we are expanding our healthcare family!About Us:Complete Care is a well-respected organization dedicated to providing exceptional healthcare services. We pride ourselves on our commitment to quality and compassion in patient care.Position Available:Practical Nursing Specialist (LPN)Why Choose Us?At Complete Care,...

  • RN Community Outreach Coordinator

    1 month ago

    Holmdel, New Jersey, United States Hackensack Meridian Health Full time

    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...

  • Office Coordinator III

    2 days ago

    Holmdel, New Jersey, United States Hackensack Meridian Health Full time

    About UsHackensack Meridian Health is a leading healthcare organization that is dedicated to providing exceptional patient care and improving the health of our community. Our team members are the heart of what makes us better, and we are committed to supporting their growth and development.Job SummaryThe Secretary III provides administrative support to the...

  • Clinical Operations Manager

    5 days ago

    Holmdel, New Jersey, United States HealthEcareers - Client Full time

    Job SummaryWe are seeking a highly skilled and experienced Clinical Operations Manager to join our team at HealthEcareers - Client. As a key member of our healthcare team, you will be responsible for the delivery of clinical services and the management of clinical and support staff.Key ResponsibilitiesLeadership and Management: Provide leadership and...

  • Marketing Manager

    1 month ago

    Holmdel, New Jersey, United States IFF Family of Companies Full time

    Requisition ID : 495160 Job Description A Marketing Manager position is available at one of the world's best fragrance and flavor companies. This New Jersey based position is hybrid offering flexibility & a collaborative work environment, experience in a fast-paced industry, and a chance to create work for both new and established brands. The position will...

  • Community Engagement Nurse Coordinator

    6 days ago

    Holmdel, New Jersey, United States Hackensack Meridian Health Full time

    Position OverviewAt Hackensack Meridian Health, our team members are integral to our mission of enhancing the health and well-being of our communities.We are dedicated to fostering a culture of collaboration and support, ensuring that our employees thrive as they contribute to the health of our patients. Competitive benefits are just the beginning; our...

  • Patient Care Technician

    2 weeks ago

    Holmdel, New Jersey, United States StaffAid Full time

    StaffAid - Position OverviewA reputable long-term care establishment is in search of Patient Care Technicians to enhance their dedicated team.Become a vital part of our esteemed and compassionate workforce. Experience the fulfillment of being a member of a respected team where your professional growth is valued and your contributions are recognized. This...

  • Sterile Processing Supervisor

    1 week ago

    Holmdel, New Jersey, United States Pride Health Full time

    Pride Health is seeking a Sterile Processing Coordinator to oversee critical functions within our healthcare facility.Position Overview:The Sterile Processing Coordinator will be responsible for ensuring the proper processing, sterilization, and management of surgical instruments and patient care equipment.Key Responsibilities:Receive, sort, and process...

  • Revenue Cycle Management Billing Supervisor

    1 week ago

    Holmdel, New Jersey, United States CentralReach Full time

    Job OverviewCentralReach stands as the premier provider of SaaS solutions tailored for autism and IDD care. With over 150,000 users relying on our services, we empower therapy providers, educators, and employers to enhance their delivery of Applied Behavior Analysis and related therapies through innovative technology and exceptional customer satisfaction.You...

  • Revenue Cycle Management Billing Supervisor

    1 week ago

    Holmdel, New Jersey, United States CentralReach Full time

    Job OverviewCentralReach stands as the leading provider of SaaS solutions tailored for autism and IDD care. With a trusted user base exceeding 150,000, we empower therapy providers, educators, and employers to enhance their delivery of Applied Behavior Analysis and related therapies through innovative technology, unparalleled industry expertise, and...