Current jobs related to Utilization Management Coordinator - Pontiac - Trinity Health

  • Utilization Management Coordinator

    3 weeks ago

    Pontiac, United States Trinity Health Full time

    Employment Type: Part time Shift: Day Shift Description: I Accountability Objectives: Applies specific criteria and payer guidelines to ensure that all health care services provided are cost effective and delivered in the most appropriate setting and optimized for quality and timeliness of the care. In collaboration with members of the health care...

  • Utilization Review Coordinator

    2 months ago

    Pontiac, United States TheraMatrix Full time

    Job DescriptionJob DescriptionDuties and Responsibilities:Initial authorizations of outpatient physical therapy services: Reviews and authorizes services that meet criteria, along with supporting documentation. It is the responsibility of the URC to ensure outpatient physical therapy services are provided at the appropriate level and are received per the...

  • Utilization Review Coordinator

    3 months ago

    Pontiac, United States TheraMatrix Full time

    Job DescriptionJob DescriptionDuties and Responsibilities:Initial authorizations of outpatient physical therapy services: Reviews and authorizes services that meet criteria, along with supporting documentation. It is the responsibility of the URC to ensure outpatient physical therapy services are provided at the appropriate level and are received per the...

  • Nurse Care Coordinator

    1 week ago

    Pontiac, Michigan, United States McLaren USA Full time

    Department: Care Management Daily Work Schedule: Day Shift 8:00 AM - 4:30 PM Scheduled Bi-Weekly Hours: - Per Diem, Weekend and other unit coverage as required Position Overview: Responsible for the proactive coordination and timely transition of assigned patients to the most suitable level of care throughout the healthcare continuum. Influences critical...

  • Behavioral Healthcare Coordinator

    3 months ago

    Pontiac, United States Oakland Community Health Network Full time

    Job DescriptionJob DescriptionJob Summary The Behavioral Healthcare Coordinator assists the public in a warm and welcoming manner with requests for Behavioral Health Services. This may include care coordination, brief solution focused therapy, motivational interviewing and case management. This role helps individuals navigate the OCHN network, utilizing OCHN...

  • Behavioral Health Services Coordinator

    1 day ago

    Pontiac, Michigan, United States Oakland Community Health Network Full time

    Job SummaryThe Behavioral Healthcare Coordinator plays a vital role in assisting individuals in need with warm and welcoming service requests for Behavioral Health Services. This position involves care coordination, brief solution-focused therapy, motivational interviewing, and case management to support individuals in navigating the Oakland Community Health...

  • Activities Engagement Coordinator

    1 week ago

    Pontiac, Michigan, United States PACE Southeast Michigan Full time

    Job OverviewACTIVITIES ENGAGEMENT COORDINATORUnder the guidance of the Life Enrichment Program Manager, in accordance with the policies and procedures of PACE Southeast Michigan, the Activities Engagement Coordinator collaborates closely with the Life Enrichment Therapist to facilitate participant involvement in enriching day center activities. These...

  • Office Coordinator

    1 week ago

    Pontiac, Illinois, United States Advanced Technology Services Full time

    Company Overview:Founded in 1985, Advanced Technology Services (ATS) operates across the United States, Mexico, and the United Kingdom, specializing in Industrial Maintenance to enhance factory operations.Key Responsibilities:- Conduct data entry and assist in developing flow charts, spreadsheets, PowerPoint presentations, interoffice memos, and professional...

  • Enrollment Management Coordinator

    3 weeks ago

    Pontiac, United States Archdiocese of Detroit Full time

    Job Title: Enrollment Management Coordinator (10 month position) Notre Dame Prep is seeking qualified applicants for the position of Enrollment Management Coordinator. The coordinator will perform a wide range of duties, ranging from administrative processes to operations management. The Enrollment Management Coordinator will provide additional support for...

  • Care Management Registered Nurse

    1 week ago

    Pontiac, Michigan, United States McLaren USA Full time

    Department: Care Management Daily Work Schedule: Day Shift 8:00 AM - 4:30 PM Scheduled Bi-Weekly Hours: - Per Diem, Weekend and other unit coverage as required Position Overview: Responsible for the proactive coordination and timely transition of assigned patients to the most suitable level of care throughout the continuum. This role significantly influences...

  • Physical Therapy Utilization Review Specialist

    1 day ago

    Pontiac, Michigan, United States TheraMatrix Full time

    Job SummaryTheraMatrix is seeking a highly skilled Physical Therapy Utilization Review Specialist to join our team. As a key member of our healthcare team, you will be responsible for reviewing and authorizing outpatient physical therapy services to ensure they meet our defined plan guidelines.Key ResponsibilitiesInitial Authorizations: Review and authorize...

  • Logistics and Inventory Coordinator

    1 week ago

    Pontiac, Michigan, United States Paslin Company Full time

    Job OverviewPosition Title: Shipping & Receiving CoordinatorReports To: Shipping & Receiving SupervisorRole Summary: The Shipping and Receiving Coordinator plays a crucial role in managing the flow of materials from the manufacturing facility to ensure alignment with project and organizational goals. This position mandates adherence to all applicable laws,...

  • Registered Nurse Care Manager

    1 month ago

    Pontiac, United States McLaren USA Full time

    Department: Care Management Daily Work Times: Day Shift 8:00 AM - 4:30 PM Scheduled Bi-Weekly Hours: 8 - Per Diem, Weekend and other unit coverage as needed Position Summary: Accountable for proactive coordination and timely transition of assigned patients to the most appropriate level of care along the continuum. Impacts key results such as achieving top...

  • IT Training Coordinator

    3 months ago

    Pontiac, United States United Wholesale Mortgage Full time

    Job DescriptionJob DescriptionOverviewReady to join thousands of talented team members who are making the dream of home ownership possible for more Americans? It’s all happening on UWM’s campus, where our award-winning workplace packs plenty of perks and amenities that keep the atmosphere buzzing with energy and excitement.It’s no wonder that out of...

  • IT Training Coordinator

    2 weeks ago

    Pontiac, United States United Wholesale Mortgage Full time

    Job DescriptionJob DescriptionOverviewReady to join thousands of talented team members who are making the dream of home ownership possible for more Americans? It’s all happening on UWM’s campus, where our award-winning workplace packs plenty of perks and amenities that keep the atmosphere buzzing with energy and excitement.It’s no wonder that out of...

  • Culinary Wellness Coordinator

    1 week ago

    Pontiac, Michigan, United States Common Ground Full time

    Position at Common Ground SUMMARY: The Culinary Wellness Coordinator is an at-will role that reports to the Director of the Crisis Residential Unit. This position is responsible for overseeing and implementing meal planning, procurement, and food preparation in alignment with Common Ground's Wellness policy while adhering to the agency's budgetary...

  • Office Administration Coordinator

    4 days ago

    Pontiac, Michigan, United States M1 Concourse LLC Full time

    Job OverviewPosition SummaryThe Office Administration Coordinator plays a pivotal role in ensuring effective communication with a diverse group of employees, clients, and vendors in a professional and efficient manner. This position is essential in delivering exceptional customer service while managing various administrative functions within the...

  • Doula Coordinator

    7 days ago

    Pontiac, United States Honor Community Health Full time $22 - $25

    Job DescriptionJob DescriptionFull Doula Coordinator Job Description (click to view)Honor Community Health is a 501c3 Federally Qualified Health Center co-located within 20 locations. Our mission is to provide for the health and wellness needs of the underserved of Oakland County through the provision of comprehensive, integrated primary, behavioral health,...

  • Logistics Coordinator

    4 days ago

    Pontiac, Michigan, United States Allegiance Staffing Full time

    Job DescriptionGENERAL SUMMARY: The role involves managing the receipt and dispatch of goods within the company's logistics framework, ensuring accurate tracking and maintaining the integrity of inventory. KEY RESPONSIBILITIES: Examine all incoming documentation related to supplier deliveries.Assess all outgoing documentation for shipments to clients.Arrange...

  • Maintenance Coordinator

    3 days ago

    Pontiac, Illinois, United States Advanced Technology Services Full time

    At Advanced Technology Services, we are a leading industrial maintenance company with a strong presence in the United States, Mexico, and the United Kingdom. Our mission is to optimize factory operations and provide exceptional service to our clients.Key Responsibilities:Assess non-urgent work requests and determine job requirements to ensure efficient and...

Utilization Management Coordinator

2 months ago

Pontiac, United States Trinity Health Full time
Employment Type:
Part timeShift:
Day Shift

Description:

I Accountability Objectives:

Applies specific criteria and payer guidelines to ensure that all health care services provided are cost effective and delivered in the most appropriate setting and optimized for quality and timeliness of the care. In collaboration with members of the health care team, conducts observation, admission, concurrent, discharge and retrospective reviews to evaluate the appropriate level of care, continued stay and status of discharge planning.

II Position Qualifications:

Minimum Education, Licensure / Certification and Experience Required.

A. Education

Associates in Nursing , Bachelor's Degree in Nursing preferred .

B. Licensure / Certification

Current RN licensure within the State of Michigan.

Certified Professional in Utilization Review/Management preferred.

C Special Skill / Aptitudes

Understanding of computers and software in order to collect and report information for required data sources.

Ability to work autonomously with little direction and be accountable for outcomes.

Excellent verbal and written communication skills.

Excellent customer service orientation skills necessary in order to deal effectively with various levels of hospital personnel, outside customers and community groups.

D. Experience

Three years recent acute care utilization management experience.

Knowledge of regulations relative to utilization review. Knowledge of Federal, State and Local regulations sources.

III Duties / Responsibilities:

1 Performs all aspects of utilization review (observation, admission, concurrent and retrospective) to ensure the medical necessity of acute care hospitalization has the existence of supportive documentation in the electronic medical record, as well as appropriate utilization of resources. Provides all external review organizations the information necessary to complete reviews and effect maximum financial reimbursement.

2 Refers all cases lacking IS/SI criteria for acute care hospitalization to the Physician Advisor or designee according to the established department guidelines.

3 Collaborates with Case Management on identifying those patients not meeting the acute care criteria and works with case manager to gather additional clinical information for reimbursement.

4 Provides consultation and information to physicians, case management and other members of the health care team regarding third party payor criteria and documentation requirements.

5 Reviews uses of diagnostic and treatment services ordered by physicians for conditions unrelated to patience's reason for hospitalization; identifies opportunities to defer those services when appropriate to reduce costs.

6 Acts as liaison between 3rd party payer case management and hospital case management to obtain the necessary clinical information to secure authorization of entire hospital stay.

7 Participates in hospital and departmental process and quality improvement initiatives.

8 Maintains competency in field as defined by continually meeting established job qualifications, competencies and certification requirements.

9 Obtains inpatient/observation orders and enters in the electronic medical record.

10 Participates in the appeal process when deemed necessary by the Denials Management Specialist on cases where payment has been denied.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.