Utilization Management Care Coordinator, RN
2 months ago
Overview
At Hackensack Meridian Health, our team members are essential to our mission of enhancing patient care and promoting healthier lives. We foster a culture of collaboration and connection, ensuring that our employees thrive in a supportive environment. Our commitment to competitive benefits is just the beginning; we prioritize mutual support and community engagement, continuously striving for improvement in healthcare delivery.
Position Summary
The Utilization Management Care Coordinator plays a vital role within the healthcare team, responsible for overseeing, communicating, and facilitating the clinical journey of patients. This position manages a specific caseload, ensuring effective planning to optimize length of stay, promote resource efficiency, and adhere to evidence-based practice standards and regulatory requirements in accordance with New Jersey nursing regulations.
Key Responsibilities
A typical day for a Utilization Management Care Coordinator may involve:
- Executing departmental protocols for utilization review tasks, including admission assessments, denial evaluations, ongoing stay reviews, and benefit terminations.
- Reviewing medical records for inpatient admissions to verify necessary documentation.
- Gathering essential records as mandated by payer agencies and initiating physician advisor reviews for questionable admissions.
- Conducting chart assessments to ensure the appropriateness of admissions and continued hospital stays based on clinical criteria, completing reviews within 24 hours or the first business day.
- 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 reporting quality concerns to the Quality Management Program.
- Engaging in multidisciplinary rounds specific to assigned units.
- Addressing issues affecting discharge and length of stay promptly.
- Conducting necessary reassessments and evaluating progress against care objectives, adjusting plans as required.
- Collaborating with the multidisciplinary team to support goals related to length of stay reduction and observation management.
- Providing patients and their families with appropriate CMS documentation as per regulatory guidelines.
- Maintaining annual competencies and completing ongoing training and education in relevant platforms.
Qualifications
Required Education, Knowledge, Skills, and Abilities:
- Bachelor of Science in Nursing (BSN) or in progress, with a commitment to obtain within three years of hire.
- Strong decision-making abilities, creativity in problem-solving, and effective leadership skills.
- Excellent verbal, written, and presentation capabilities.
- Moderate to advanced computer proficiency.
- Familiarity with hospital and community resources, as well as utilization management processes.
Licenses and Certifications Required:
- New Jersey State Professional Registered Nurse License.
- AHA Basic Health Care Life Support HCP Certification.
Preferred Licenses and Certifications:
- Certified Case Manager (CCM), Certified Clinical Medical Assistant (CCMA), or certification from the American Case Management Association (ACMA) is strongly preferred.
-
Care Coordinator, Utilization Management RN
1 month ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleWe are seeking a highly skilled Care Coordinator, Utilization Management RN to join our team at Hackensack Meridian Health. As a key member of our healthcare team, you will be responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment.ResponsibilitiesConduct thorough reviews of medical records to...
-
Care Coordinator, Utilization Management RN
6 days ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeJob SummaryThe Care Coordinator, Utilization Management RN is a key member of the healthcare team responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment. This role involves managing a designated patient caseload, planning effectively to manage length of stay, promote efficient utilization of resources, and...
-
Care Coordinator, Utilization Management RN
1 month ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleAt Hackensack Meridian Health, we're committed to delivering exceptional patient care and advancing our mission to transform healthcare. As a Care Coordinator, Utilization Management RN, you'll play a vital role in our team's success.Key ResponsibilitiesConduct thorough reviews of medical records to determine the appropriateness of patient...
-
Care Coordinator, Utilization Management RN
2 weeks ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleHackensack Meridian Health is seeking a skilled Care Coordinator, Utilization Management RN to join our team. As a key member of our healthcare team, you will be responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment.Key ResponsibilitiesManage a designated patient caseload, planning...
-
Care Coordinator, Utilization Management RN
4 weeks ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleHackensack Meridian Health is seeking a highly skilled Care Coordinator, Utilization Management RN to join our team. As a key member of our healthcare team, you will be responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment.ResponsibilitiesConduct thorough reviews of patient medical records...
-
Care Coordinator, Utilization Management RN
2 months ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleHackensack Meridian Health is seeking a skilled Care Coordinator, Utilization Management RN to join our team. As a key member of our healthcare team, you will be responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment.Key ResponsibilitiesConduct thorough reviews of patient medical records to...
-
Care Coordinator, Utilization Management RN
4 weeks ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleWe are seeking a highly skilled Care Coordinator, Utilization Management RN to join our team at Hackensack Meridian Health. As a key member of our healthcare team, you will be responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment.ResponsibilitiesConduct thorough reviews of medical records to...
-
Care Coordinator, Utilization Management RN
2 weeks ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleAs a Care Coordinator, Utilization Management RN at Hackensack Meridian Health, you will play a vital role in coordinating, communicating, and facilitating the clinical progression of patients' treatment. This position requires a strong understanding of healthcare regulations, payor requirements, and evidence-based practice...
-
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleWe are seeking a highly skilled Care Coordinator, Utilization Management to join our team at Hackensack Meridian Health. As a key member of our healthcare team, you will be responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment.Key ResponsibilitiesConduct thorough reviews of medical records...
-
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeJob SummaryWe are seeking a highly skilled Care Coordinator, Utilization Management to join our team at Hackensack Meridian Health. As a key member of our healthcare team, you will be responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment.Key ResponsibilitiesConduct thorough reviews of medical records to...
-
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeJob Title: Care Coordinator, Utilization ManagementAt Hackensack Meridian Health, we are committed to delivering exceptional patient care and improving the healthcare experience. As a Care Coordinator, Utilization Management, you will play a vital role in ensuring that our patients receive the most effective and efficient care...
-
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleAt Hackensack Meridian Health, we're committed to delivering exceptional patient care and advancing our mission to transform healthcare. As a Care Coordinator, Utilization Management, you'll play a vital role in coordinating, communicating, and facilitating the clinical progression of patient treatment.Key ResponsibilitiesConduct thorough...
-
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeJob SummaryThe Care Coordinator, Utilization Management is a key member of the healthcare team responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment. This role involves managing a designated patient caseload, planning effectively to manage length of stay, and promoting efficient utilization of...
-
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeJob SummaryWe are seeking a highly skilled Clinical Care Coordinator, Utilization Management Specialist to join our team at Hackensack Meridian Health. This role is responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment, ensuring that care meets evidence-based practice standards and regulatory...
-
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeJob SummaryWe are seeking a highly skilled Care Coordinator, Utilization Management to join our team at Hackensack Meridian Health. As a key member of our healthcare team, you will be responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment. Your expertise will ensure that care meets evidence-based practice...
-
Utilities Manager
2 weeks ago
Hackensack, New Jersey, United States A&E PROPERTIES II MGMT LLC Full timeJob Title: Utilities ManagerA&E Properties II Mgmt LLC is seeking a skilled Utilities Manager to join our team. As a key member of our accounting department, you will be responsible for managing all utility accounts, ensuring accuracy, and maintaining a comprehensive utilities database.Key Responsibilities:Coordinate with the India Accounts Payable Team and...
-
Care Coordinator, Care Management
2 weeks ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeCare Coordinator, Care ManagementAt Hackensack Meridian Health, we are seeking a skilled Care Coordinator, Care Management to join our team. As a key member of our healthcare team, you will be responsible for coordinating, communicating, and facilitating the clinical progression of patients' treatment and discharge plans.Key Responsibilities:Assess patients'...
-
Care Coordinator, Care Management
1 month ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeCare Coordinator, Care Management Job DescriptionJob Summary:The Care Coordinator, Care Management is a member of the healthcare team responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment and discharge plan. This role requires effective decision-making skills, creativity in problem-solving, and...
-
Care Coordinator, Care Management Specialist
6 days ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleWe are seeking a skilled Care Coordinator, Care Management to join our team at Hackensack Meridian Health. As a member of our healthcare team, you will be responsible for coordinating, communicating, and facilitating the clinical progression of patients' treatment and discharge plans.Key ResponsibilitiesAssess patients to identify potential...
-
Care Coordinator, Care Management Specialist
2 months ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleWe are seeking a highly skilled and compassionate Care Coordinator to join our team at Hackensack Meridian Health. As a key member of our healthcare team, you will play a vital role in coordinating, communicating, and facilitating the clinical progression of patient treatment and discharge plans.ResponsibilitiesAssessment and Planning: Assess...
