Care Management, Care Coordinator, Utilization Management-Night
4 weeks 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.
This is a Remote, Night position, the hours are 11pm-7:30am. Utlization Management experience is preferred.
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.
- 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 Center's Organization Competencies and the Standard of Behavior.
- Other duties as assigned.
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
We have other current jobs related to this field that you can find below
-
Primary Care Physician
2 weeks ago
Oceanport, New Jersey, United States AcuteCare Health System LLC Full timeCOME JOIN OUR TEAMPrimary Care Physician - Great BENEFITS Beacon of LIFE's mission is to provide the newest healthcare and social service choices for elders living in Monmouth County and Ocean County. The Beacon of LIFE center was established to deliver PACE (Program of All-Inclusive Care for the Elderly) services. The PACE model is centered on the belief...
-
Primary Care Physician
1 month ago
Oceanport, United States AcuteCare Health System Full timeCOME JOIN OUR TEAM!!! Primary Care Physician - Great BENEFITS!!! Beacon of LIFE's mission is to provide the newest healthcare and social service choices for elders living in Monmouth County and Ocean County. The Beacon of LIFE center was established to deliver PACE (Program of All-Inclusive Care for the Elderly) services. The PACE model is centered on the...
-
Manager, Corporate Reimbursement
3 weeks ago
Oceanport, United States RWJBarnabas Health Full time**Job Overview**: The manager is to work with the VP of Reimbursement to ensure all cost reports are submitted by due date and meet regulations. Manager is to ensure all third-party schedules are completed monthly. **Qualifications**: - Required:_ - A Bachelor of Science degree with a major in accounting is required. - Must have at least eight years...
-
Primary Care Physician
4 weeks ago
Oceanport, United States BoldAge PACE Full timeJob DescriptionJob DescriptionCOME JOIN OUR TEAM!!!Primary Care Physician - Great BENEFITS!!!Beacon of LIFE’s mission is to provide the newest healthcare and social service choices for elders living in Monmouth County and Ocean County. The Beacon of LIFE center was established to deliver PACE (Program of All-Inclusive Care for the Elderly) services. The...
-
Primary Care Physician
4 weeks ago
Oceanport, United States AcuteCare Health System LLC Full timeCOME JOIN OUR TEAM!!! Primary Care Physician - Great BENEFITS!!! Beacon of LIFE’s mission is to provide the newest healthcare and social service choices for elders living in Monmouth County and Ocean County. The Beacon of LIFE center was established to deliver PACE (Program of All-Inclusive Care for the Elderly) services. The PACE model is centered on the...
-
Primary Care Physician
4 weeks ago
Oceanport, United States AcuteCare Health System LLC Full timeCOME JOIN OUR TEAM!!! Primary Care Physician - Great BENEFITS!!! Beacon of LIFE’s mission is to provide the newest healthcare and social service choices for elders living in Monmouth County and Ocean County. The Beacon of LIFE center was established to deliver PACE (Program of All-Inclusive Care for the Elderly) services. The PACE model is centered on the...
-
Registered Nurse RN
4 weeks ago
Oceanport, United States Monmouth Medical Center Full timeSummary of Job Function: The Registered Nurse provides nursing care in the health care system within the scope of practice defined by the Nurse Practice Act and regulatory standards and assures awareness of ethical standards of practice as defined by the ANA code of ethics. The Registered Nurse assures safety in practice and is inclusive of the principles...
-
Registered Nurse RN
5 days ago
Oceanport, United States Monmouth Medical Center Full timeSummary of Job Function: The Registered Nurse provides nursing care in the health care system within the scope of practice defined by the Nurse Practice Act and regulatory standards and assures awareness of ethical standards of practice as defined by the ANA code of ethics. The Registered Nurse assures safety in practice and is inclusive of the principles of...
-
Business Operation Manager- PACE
7 days ago
Oceanport, United States BoldAge PACE Full timeJob DescriptionJob DescriptionCOME JOIN OUR TEAM!!!Business Operation Manager BoldAge delivers innovative, creative solutions for PACE (Program of All-Inclusive Care of the Elderly). Our model of care enables older adults to live a meaningful, independent life at home with grace and indignity.We meet the evolving needs of older adults by providing innovative...
-
Unit Nurse Leader RN
4 weeks ago
Oceanport, United States Monmouth Medical Center Full timeMonmouth Medical Center (MMC) is one of New Jersey's largest community teaching hospitals, where physicians and employees work as a team dedicated to academic and clinical excellence and comprehensive, compassionate patient care. As part of RWJ Barnabas Health, Monmouth Medical Center is a leader in designing unparalleled new ways for delivering health care....
-
Physician- Primary Care
3 weeks ago
Oceanport, United States TEEMA Full timeJob DescriptionJob DescriptionJob Title: PhysicianJob ID: 65693Location: Oceanport, New JerseyOverview:Our client is seeking a Physician to provide direct primary medical care to patients and supervise medical care personnel, including PCP Nurse Practitioners, RNs, and Certified Medical Assistants. The Physician will deliver care within the...
-
Physician- Primary Care
4 weeks ago
Oceanport, United States TEEMA Full timeJob DescriptionJob DescriptionJob Title: PhysicianJob ID: 65693Location: Oceanport, New JerseyOverview:Our client is seeking a Physician to provide direct primary medical care to patients and supervise medical care personnel, including PCP Nurse Practitioners, RNs, and Certified Medical Assistants. The Physician will deliver care within the...
-
Unit Nurse Leader RN
4 weeks ago
Oceanport, United States Monmouth Medical Center Full timeMonmouth Medical Center (MMC) is one of New Jersey's largest community teaching hospitals, where physicians and employees work as a team dedicated to academic and clinical excellence and comprehensive, compassionate patient care. As part of RWJ Barnabas Health, Monmouth Medical Center is a leader in designing unparalleled new ways for delivering health care....
-
Unit Nurse Leader RN
5 days ago
Oceanport, United States Monmouth Medical Center Full timeMonmouth Medical Center (MMC) is one of New Jersey's largest community teaching hospitals, where physicians and employees work as a team dedicated to academic and clinical excellence and comprehensive, compassionate patient care. As part of RWJ Barnabas Health, Monmouth Medical Center is a leader in designing unparalleled new ways for delivering health...
-
Registered Nurse RN
5 days ago
Oceanport, United States Monmouth Medical Center Full timeSummary of Job Function: The Registered Nurse provides nursing care in the health care system within the scope of practice defined by the Nurse Practice Act and regulatory standards and assures awareness of ethical standards of practice as defined by the ANA code of ethics. The Registered Nurse assures safety in practice and is inclusive of the principles of...
-
Registered Nurse RN
4 days ago
Oceanport, United States Monmouth Medical Center Full timeSummary of Job Function: The Registered Nurse provides nursing care in the health care system within the scope of practice defined by the Nurse Practice Act and regulatory standards and assures awareness of ethical standards of practice as defined by the ANA code of ethics. The Registered Nurse assures safety in practice and is inclusive of the principles of...
-
Oceanport, NJ, United States Monmouth Medical Center Full timeThe Registered Nurse provides nursing care in the health care system within the scope of practice defined by the Nurse Practice Act and regulatory standards and assures awareness of ethical standards of practice as defined by the ANA code of ethics. The Registered Nurse assures safety in practice and is inclusive of the principles of evidence based practice...
-
Registered Nurse RN
4 weeks ago
Oceanport, United States Monmouth Medical Center Full timeSummary of Job Function: The Registered Nurse provides nursing care in the health care system within the scope of practice defined by the Nurse Practice Act and regulatory standards and assures awareness of ethical standards of practice as defined by the ANA code of ethics. The Registered Nurse assures safety in practice and is inclusive of the principles of...
-
Registered Nurse RN
4 weeks ago
Oceanport, NJ, United States Monmouth Medical Center Full timeSummary of Job Function: The Registered Nurse provides nursing care in the health care system within the scope of practice defined by the Nurse Practice Act and regulatory standards and assures awareness of ethical standards of practice as defined by the ANA code of ethics. The Registered Nurse assures safety in practice and is inclusive of the principles of...
-
RN-Medical Care Unit
4 weeks ago
Oceanport, NJ, United States RWJBarnabas Health Corporate Services Full timeSystem Float RN is an expert member of the System-wide Float Pool possessing exemplary care skills and knowledge with professionalism, cooperation and accountability. Organizes and administers individualized age specific professional care to patients within an assigned unit of the hospital in support of medical care. RWJBarnabas Health is seeking experienced...
