Clinical Utilization Coordinator
2 weeks ago
Location
Cantex Continuing Care Network
Category
Healthcare Services
Role Summary
Cantex Continuing Care Network is seeking a Clinical Utilization Coordinator to oversee the clinical management and leadership of Utilization Management, Referral, and Precertification processes. This role involves the assessment of clinical data, execution of utilization management evaluations, and comprehensive reporting of intake data. The ideal candidate will possess clinical licensure in a relevant field and demonstrate the ability to lead, manage, and orient intake and utilization management personnel.
Benefits Offered:
- Competitive Salary
- 401k Plan with Employer Match
- Comprehensive Medical, Dental, Vision, and Supplemental Insurance
- Paid Time Off including Vacation, Sick Leave, Personal Holidays, and Paid Holidays
- Short-Term Disability Coverage
- Life Insurance Options
- Tuition and Continuing Education Reimbursement
- Flexible Pay Options with PayActiv
- Employee Recognition and Rewards Program
- Bachelor's degree in Nursing, Social Work, Counseling, Psychology, or a related clinical discipline is mandatory
- Master's degree is preferred
- A minimum of 3 years of experience in utilization management or quality improvement
- Solid understanding of fundamental utilization management and quality improvement principles
- Prior experience in a leadership role or managing cross-functional teams on significant projects
- At least two years of clinical experience in a hospital environment; supervisory experience is advantageous
- Current, unrestricted State Nursing license (RN) or Clinical Social Worker license in good standing
- Oversee daily operations of the Utilization Management and Intake departments
- Ensure effective utilization of resources to streamline the UM/Intake process
- Support consistent data collection from UM staff to help the organization meet its corporate objectives and improve monitoring and reporting to satisfy external standards
- Identify and implement process enhancements to improve departmental functions
- Provide education and training to staff to ensure adherence to performance standards
- Assist the UM Manager and Director in coordinating processes with providers, partners, vendors, and subcontractors as needed
- Develop and mentor intake and UM staff
- Manage the workload and productivity of Intake Coordinators and/or Clinical UM Staff
- Conduct internal chart audits
- Prepare Utilization Management reports, letters, and clinical analysis documents as required
- Collaborate with other departments within the organization
- Identify areas for workflow improvement
- Process and complete data entry for demographic information related to referral and authorization requests from providers
- Ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA)
- Participate in monthly departmental and interdepartmental meetings as appropriate
- Coordinate staff work hours, including scheduling, approving time off requests, tracking absences, and managing overtime
- Conduct performance reviews and provide input on employee evaluations and disciplinary actions
- Perform additional duties as assigned
Diversity, Equity, and Inclusion are fundamental values at Cantex. We are dedicated to fostering a culture that honors our differences and appreciates the contributions of all individuals.
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