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Care Coordination Specialist in Utilization Management

2 months ago

Brick, United States Hackensack Meridian Health Full time
Position Overview

At Hackensack Meridian Health, our workforce is integral to our mission of enhancing patient care and fostering a supportive environment. We are dedicated to helping our patients achieve healthier lives while promoting a culture of teamwork and collaboration among our staff. Our competitive benefits package is just the beginning; we prioritize mutual support and community engagement, driving our commitment to positive change in healthcare.

The Utilization Management Coordinator plays a vital role within the healthcare team, tasked with the coordination, communication, and facilitation of patient treatment pathways. This position is accountable for managing a specific patient caseload, ensuring effective planning to optimize length of stay, resource utilization, and adherence to evidence-based practices and regulatory standards.

Key Responsibilities

A typical day for a Utilization Management Coordinator at Hackensack Meridian Health involves:

  • Executing departmental protocols for utilization review processes, including admission assessments, denial management, and ongoing stay evaluations.
  • Reviewing and assessing medical documentation for inpatient admissions to confirm the presence of necessary records.
  • Collecting required documentation for payer agencies and initiating physician advisor reviews for questionable admissions.
  • Conducting chart evaluations to determine the appropriateness of admissions and continued hospital stays, ensuring reviews are completed promptly.
  • Referring cases that do not meet established criteria to the physician advisor or designated vendor for further evaluation.
  • Actively participating in relevant committees, workgroups, and meetings.
  • Identifying and escalating quality concerns to the Quality Management Program.
  • Engaging in multidisciplinary rounds specific to assigned units, addressing issues that may affect discharge and length of stay.
  • Performing necessary reassessments and tracking progress against care objectives, adjusting plans as required.
  • Collaborating with the multidisciplinary team to support initiatives aimed at reducing length of stay and managing observation cases.
  • Providing patients and their families with essential CMS documentation in accordance with regulatory guidelines.
  • Maintaining annual competencies and completing necessary training and continuing education across relevant platforms.
  • Adhering to the organization's competencies and standards of behavior.
  • Executing additional responsibilities as assigned.
Qualifications
  • Bachelor of Science in Nursing (BSN) or currently pursuing a BSN with a commitment to complete within three years of hire.
  • Strong decision-making abilities, creativity in problem-solving, and effective leadership skills.
  • Exceptional verbal, written, and presentation capabilities.
  • Proficient computer skills.
  • Familiarity with hospital and community resources, as well as utilization management practices.
  • New Jersey State Professional Registered Nurse License is mandatory.
  • AHA Basic Health Care Life Support HCP Certification is required.
  • Certification in Care Management from a nationally recognized organization is expected within one year.

This position is specific to the Emergency Department, with the expectation that the team member will spend a significant portion of their day in this setting.

About Hackensack Meridian Health

Hackensack Meridian Health (HMH) is committed to mandatory influenza vaccination for all staff.

As part of our dedication to supporting your career journey, we may share your resume with other departments within the Hackensack Meridian Health network that align with your skills and experience.