Medical Care Coordinator Specialist

1 day ago


Hawthorne, California, United States Stability Direct Full time
About the Role

We are seeking a highly skilled Medical Care Coordinator Specialist to join our team at Stability Direct, a leading healthcare staffing partner.

Job Summary

The Medical Care Coordinator Specialist will perform comprehensive assessments on admission, utilizing established tools for high-risk indicators to ensure that patients receive appropriate supportive services for discharge and prevent readmission. The role involves ongoing reassessment of patient needs throughout their hospital course and performing Utilization Review activities as per department policy.

Key Responsibilities
  • Complete comprehensive initial assessments using standardized tools and criteria;
  • Perform multidisciplinary care coordination at both intra-hospital and inter-hospital levels of care;
  • Conduct transitional planning activities, including patient education, arrangement of aftercare, commercial payer involvement, and identification of high-utilizer patient root causes;
  • Communicate relevant patient information to health team members and ensure alignment with department goals regarding LOS reduction, readmission prevention, denial reduction, and satisfaction improvement;
  • Document all activities according to department requirements;
  • Participate in Performance Improvement activities as needed;
  • Perform all Utilization Review activities, including commercial payer reviews, disposition determinations, retro/self-audit, MC variance, and admission clinical review.
Requirements
  • Bachelor's degree in Nursing (BSN) or related field required;
  • At least 5 years of clinical experience in ED, critical care, or med/surg settings;
  • Previous case management experience preferred;
  • Familiarity with healthcare financial, regulatory, and payer issues strongly preferred;
  • Knowledge of state, local, and federal programs desired;
  • Experience with Milliman/InterQual criteria required;
  • NYS RN license mandatory;
  • PRI/Screen certification and CCM certification highly desirable;
  • Strong computer skills essential.
Compensation and Benefits

The successful candidate can expect a competitive salary ranging from $120,000 to $154,000 annually, plus benefits and opportunities for professional growth and development.



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