RN - LEAD CARE COORDINATOR - Utilization Review Manager

3 weeks ago


Maywood, California, United States Trinity Health Full time
Job Summary:

Trinity Health is seeking a skilled Lead Care Coordinator to oversee the daily caseloads of the Utilization Review/Management teams. This role involves utilization review of inpatient medical and behavioral health services to assess appropriateness of level of care and collaborate with case managers to facilitate transition to the most appropriate level of care.

Key Responsibilities:

Evaluate medical necessity of preauthorization requests utilizing defined criteria.
Collect, analyze, and communicate relevant utilization management information to insurers and third-party payers.
Develop, implement, and monitor administrative and clinical processes to ensure staff activities are focused on achieving the LPP program goals to improve quality of care, mitigate cost trends through supporting optimization of utilization review for medical necessity using established care guidelines and ensuring benefits are covered by the health plan.
Coordinate assignment of daily work, ensure work completed within required timeframes, and examine work product to ensure it meets department clinical and process guidelines.
Provide feedback to staff on performance, including identifying performance improvement opportunities and working collaboratively with staff to develop and implement remediation plans.

Requirements:

Bachelor's Degree in a related field.
3-5 years of previous job-related experience, with leadership experience preferred.
Current Registered Nurse License in the State of Illinois.

Our Commitment to Diversity and Inclusion:

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. We recognize that each of us has a different way of thinking and perceiving our world, and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce, commitment and accountability, communication, community partnerships, and supplier diversity. We are an Equal Opportunity Employer and welcome applicants from diverse backgrounds.
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