Care Coordination Specialist

2 weeks ago

Brick, United States Hackensack Meridian Health Full time
Position Overview

At Hackensack Meridian Health, our team members are essential to enhancing the quality of care we provide. We are dedicated to supporting our patients in leading healthier lives while fostering an environment of collaboration and growth among our staff. Our culture emphasizes connection, teamwork, and community engagement, ensuring that our employees are valued contributors to our mission of transforming healthcare.

The Utilization Management Coordinator plays a vital role within the healthcare team, focusing on the organization, communication, and facilitation of the clinical progression of patient care. This position is accountable for a specific patient caseload, ensuring effective planning to manage the length of stay, optimize resource utilization, and maintain compliance with evidence-based practices and regulatory requirements.

Key Responsibilities

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

  • Adhering to departmental protocols for utilization review processes, including admission assessments, denial management, and benefit terminations.
  • Collecting and analyzing medical documentation for inpatient admissions to verify completeness and compliance.
  • Requesting necessary records from payer agencies and coordinating physician reviews for questionable admissions.
  • Conducting thorough chart evaluations to assess the appropriateness of admissions and ongoing hospital stays based on established clinical criteria.
  • Escalating cases that do not meet criteria to the physician advisor or designated vendor for further evaluation.
  • Actively participating in relevant committees, workgroups, and meetings to contribute to quality improvement initiatives.
  • Identifying and reporting quality concerns to the Quality Management Program for further investigation.
  • Engaging in multidisciplinary rounds to address issues affecting discharge and length of stay promptly.
  • Performing regular reassessments to evaluate progress towards care objectives and adjusting plans as necessary.
  • Collaborating with the multidisciplinary team to achieve goals related to length of stay reduction and observation management.
  • Providing essential CMS documentation to patients and their families in accordance with regulatory guidelines.
  • Maintaining annual competencies and completing required training and continuing education in relevant platforms.
  • Complying with the Medical Center's Organizational Competencies and Standards of Behavior.
  • Other 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, innovative problem-solving skills, and effective leadership capabilities.
  • Excellent verbal, written, and presentation communication skills.
  • Proficient computer skills with moderate to advanced knowledge.
  • Familiarity with hospital and community resources, as well as utilization management practices.
  • New Jersey State Professional Registered Nurse License is required.
  • AHA Basic Health Care Life Support HCP Certification is mandatory.
  • Care Management certification from a nationally recognized organization to be obtained within one year.

*This position is specific to the Emergency Department, with the expectation that the team member will spend the majority of their working hours in this area.

About Hackensack Meridian Health

Hackensack Meridian Health (HMH) is committed to providing a safe and healthy environment for all employees and patients.

We are dedicated to supporting your career development and will assist in connecting you with other opportunities within our network that align with your skills and experience.

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