Care Coordinator RN, Utilization Management
3 months ago
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. Its 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.
Responsibilties: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
- 1Collaborates 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 Center's 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
Required Preferred Job Industries- Other
-
UM Coordinator
2 weeks ago
Montgomery Twp, United States Hackensack Meridian Health Full timeOur 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...
-
Director of Utilization Management
4 days ago
Bloomfield Twp, MI, USA, United States Acadia Healthcare Inc. Full timeUtilization Review SpecialistAcadia Healthcare Inc. is seeking a highly skilled Utilization Review Specialist to optimize reimbursement and ensure the best possible care for our patients.Optimize Reimbursement and Patient CareConcurrent and Retrospective ReviewsLiaison and CollaborationStaff Management and DevelopmentProgram Evaluation and ComplianceKey...
-
Patient Services Coordinator
2 days ago
Wall Twp, United States Cooper University Health Care Full timeAbout the Role:As a Patient Services Representative at Cooper University Health Care, you will play a vital role in ensuring exceptional patient experiences. Your primary responsibility will be to serve as the front-line contact person for all incoming patients, providing top-notch customer service and support.Key Responsibilities:Greet, register, and...
-
Clinical Team Coordinator RN
3 weeks ago
Elmhurst Twp, United States Geisinger Health System Full timeJob Title: Clinical Team Coordinator RN - Cardiac Special Care Unit Location: Scranton, Pennsylvania Job Category: Inpatient RN - Registered Nurse, Nursing and Nursing Support Schedule: Days Work Type: Full time Department: GCMC Cardiac Nursing Division Date Posted: 11/21/2023 Job ID: R-00524 Job Summary Coordinates and supervises the delivery of nursing...
-
Supervisor, Secondary Education
2 days ago
Millstone Twp, United States Hackensack Meridian Health Full timeDescription: 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. Its also about how we support one...
-
Egg Harbor Twp, United States AtlantiCare Full timeJob DescriptionPosition:Physician Advisor, Clinical Documentation Improvement Utilization ManagementPRIMARY SCOPE OF SERVICE: The Physician Advisor CDI/UM works closely with the medical staff leadership, the entire medical staff, including resident physician house staff, and coding and CDI to ensure physician clinical documentation is accurate and complete...
-
Clinical Patient Care Manager
3 months ago
Cranberry Twp, United States VITAS Healthcare Full timeJob DescriptionThe Team Manager is the leader of the Patient Care Team and that member of the team whose function is to: supervise, evaluate and coordinate the various component members of the interdisciplinary team; assure continuity of care from admission to discharge or transfer to bereavement; serve as patient advocate and coordinator for other social...
-
Physical Therapist
5 days ago
Millstone, Kentucky, United States Career Tree Network Full timeAbout the Role:We are seeking a skilled Physical Therapist to join our multidisciplinary therapy team in the Millstone, NJ area. As a Physical Therapist with Career Tree Network, you will have the opportunity to work with a well-balanced mix of patients in their homes, providing outpatient therapy in a home-based setting.Key Responsibilities:Provide...
-
Egg Harbor Twp, United States AtlantiCare Full timeJob DescriptionPosition:Physician Advisor, Clinical Documentation Improvement Utilization Management PRIMARY SCOPE OF SERVICE: The Physician Advisor CDI/UM works closely with the medical staff leadership, the entire medical staff, including resident physician house staff, and coding and CDI to ensure physician clinical documentation is accurate and complete...
-
Egg Harbor Twp, United States AtlantiCare Full timeJob DescriptionPosition:Physician Advisor, Clinical Documentation Improvement Utilization Management PRIMARY SCOPE OF SERVICE: The Physician Advisor CDI/UM works closely with the medical staff leadership, the entire medical staff, including resident physician house staff, and coding and CDI to ensure physician clinical documentation is accurate and complete...
-
Outside Parts Sales Representative
1 week ago
Millstone Twp, United States Hunter Truck Full timeHunter Truck is seeking a skilled Outside Parts Sales Representative to become a vital part of our dynamic and dedicated team. As a family-owned and authorized dealer of Peterbilt trucks, Hunter Truck has been delivering exceptional trucking solutions and a steadfast commitment to personalized service, parts, and sales for generations. Since 1938, we have...
-
RN Supervisor
2 days ago
East Norriton Twp, United States SNF Rehab & Healthcare Full timeJob SummaryWe are seeking a highly skilled and experienced RN Supervisor to join our team at SNF Rehab & Healthcare. As a key member of our nursing staff, you will be responsible for providing exceptional care to our residents and leading our team of caregivers.Key ResponsibilitiesLeadership and Supervision: Provide guidance and oversight to our direct care...
-
Registered Nurse
2 months ago
Boardman Twp, United States Bon Secours Mercy Health Full timeAt Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. Summary of Primary Function/General Purpose of Position The Stepdown Registered Nurse (RN) delivers patient care utilizing the nursing...
-
LPN Care Coordination Specialist
2 weeks ago
Clinton Twp, United States Gentiva Hospice Full timeAbout Gentiva HospiceGentiva Hospice is a prominent leader in the field of hospice and palliative care, dedicated to providing exceptional support to patients facing advanced illnesses. Our clinical teams collaborate closely with physicians and specialists to deliver advanced illness management, focusing on alleviating symptoms and enhancing the quality of...
-
Business Development Manager
1 day ago
Millstone, United States Valcourt Group Full timeJob DescriptionJob DescriptionThe Business Development Manager will be responsible for building a portfolio of target customers, educating them about the company’s services, and pursuing opportunities for growth. This is a foundation building opportunity to interact with potential customers (owners, property managers, consulting engineers) by way of...
-
Wall Twp, United States Utilities One Full timeAbout The RoleCompany OverviewUtilities One was established with the ambition to transform the utility sector. Our mission is to create a significant positive impact on the communities we serve.Currently, Utilities One provides a comprehensive array of infrastructure solutions for Telecommunications providers, Electric, Water & Gas Utilities, Wireless...
-
RN Case Manager
1 week ago
Delhi Twp, United States Interim HealthCare Full timeOur Registered Nurse Case Managers (RNCM) have been called to care when they're needed most. At Interim HealthCare, you'll support a full range of patient services to bring comfort and dignity to our clients. What we offer our Registered Nurse Case Managers (RNCM): Competitive pay, benefits, and incentives. Truly flexible scheduling - a...
-
Registered Nurse
1 day ago
Mifflin Twp, United States Consulate Health Care Full timeRN | per hour | Mifflin, PA, USA | Hourly | Locust Grove Retirement Village | Full Time Looking for qualified Licensed RN's to join our team at the Locust Grove Retirement Village! New Grads Welcome! Hiring Dayshift You will have shift options, flexibility to build your schedule, a competitive base salary, lucrative employee referral program, opportunity...
-
RN Bed Management
1 day ago
Climax Twp, United States Corewell Health Full timeAbout Corewell Health Our new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage, we create more value. Through compassion, collaboration, clarity, curiosity and courage, we make anything and everything possible....
-
Foster Care Program Coordinator
1 week ago
Baltimore Twp, United States Lutheran Immigration and Refugee Service Full timePosition OverviewIf you are dedicated to making a meaningful impact in communities through a mission-focused organization, this role may be the perfect fit for you.The Foster Care Program Coordinator will oversee and manage a range of Foster Care initiatives to guarantee comprehensive, culturally sensitive support for unaccompanied refugee and migrant...
