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Clinical Care Coordinator
2 months ago
Montefiore Medical Center is seeking a highly skilled Clinical Care Coordinator to join our Utilization Management team. As a key member of our team, you will be responsible for coordinating the continuum of medical care services for patients to ensure optimum utilization of resources, delivery of quality patient care, and compliance with regulatory, accrediting, and contractual requirements.
Key Responsibilities- Coordinate patient care services to ensure efficient use of resources and delivery of quality care.
- Determine the appropriateness of patient care services and prepare clinical appeals for third-party denials.
- Collect and interpret data for utilization, compliance, quality improvement, and other areas as assigned.
- Develop and implement strategies to improve patient outcomes and reduce healthcare costs.
- Collaborate with healthcare providers, payers, and other stakeholders to ensure seamless care coordination.
- Stay up-to-date with regulatory requirements, industry trends, and best practices in utilization management and case management.
- BSN or a bachelor's degree in a related field required; Master's preferred.
- NYS RN License required.
- PRI assessor number required prior to end of 3-month probationary period.
- 3-5 years recent acute care clinical experience preferred.
- Experience in utilization management and case management preferred.
- Certification in Utilization Review or Case Management preferred.
- Excellent analytical, problem-solving, conflict resolution, and negotiation skills.
- Demonstrated knowledge of federal, state, and commercial/third-party regulations related to utilization management functions, discharge planning, and associated processes.
- Demonstrated knowledge of quality/performance improvement tools and techniques.
- Demonstrated knowledge of utilization and case management principles.
- Experience in the application of utilization management decision support criteria preferred.
- Computer skills, including data entry, word processing, and electronic messaging.
- Experience in the use of Windows-based software applications.
- Experience in the use of an electronic clinical information system preferred.
- Excellent verbal, written, and interpersonal communication skills, as well as a commitment to interdisciplinary teamwork.
- Excellent organization, teamwork, and time management skills.
- Expert clinical knowledge of disease processes to identify care needs.
- Understanding of the healthcare delivery system and its sites of care, delivery models, and the roles of various providers and healthcare professionals.
- Experience in interpreting and applying benefit coverage rules and assessing coordination of benefits guidelines and managed care regulations required.
Montefiore Medical Center is one of the nation's largest academic medical centers. We are a growing organization and one of New York's top employers. Join us as we further our reputation as a leader in clinical care, healthcare research, education, and social commitment.
