Care Coordination Specialist
1 week ago
Overview:
At Hackensack Meridian Health, our team members are the foundation of our commitment to excellence.
We are dedicated to enhancing the lives of our patients while fostering an environment where our employees can thrive.
Our culture emphasizes connection and collaboration, ensuring that our staff are integral members of our community.Competitive benefits are just the start; our focus is on mutual support and community engagement. Together, we strive for continuous improvement, advancing our mission to revolutionize healthcare and lead positive change.
The Care Management, Care Coordinator, Utilization Management role is a vital part of the healthcare team, responsible for coordinating, communicating, and facilitating the clinical progression of patient care.
With accountability for a specific patient caseload, the Care Coordinator, Utilization Management effectively plans to manage length of stay, promote efficient resource utilization, and ensure that care adheres to evidence-based practice standards and regulatory requirements.
Qualifications:
BSN or BSN in progress, with a commitment to obtain within three years of hire or transfer.
Strong decision-making abilities, creativity in problem-solving, and influential leadership qualities.
Exceptional verbal, written, and presentation skills.
Proficient computer skills, ranging from moderate to expert.
Knowledgeable about hospital and community resources, as well as utilization management practices.
New Jersey State Professional Registered Nurse License is mandatory.
AHA Basic Health Care Life Support HCP Certification is required.
Certification in Care Management from a nationally recognized organization within one year is expected.
*This position is specific to Utilization Review in the Emergency Department, with the expectation of spending the majority of the workday in this setting.
If this description resonates with your skills and expertise, we encourage you to consider this opportunity.
Responsibilities:
A typical day for a Care Management, Care Coordinator, Utilization Management at Hackensack Meridian Health includes:
Adhering to departmental workflows for utilization review activities, which encompass admission reviews, denials, continued stay evaluations, and retrospective medical record reviews.
Securing necessary records as mandated by payer agencies and initiating physician advisor reviews for unjustified admissions.
Conducting chart reviews to assess the appropriateness of admissions and ongoing hospital stays, applying relevant clinical criteria. Admission reviews should be completed within 24 hours or by the first business day.
Referring cases that do not meet criteria to the physician advisor or designated vendor for further evaluation and action.
Actively participating in relevant committees, workgroups, and meetings.
Identifying and referring quality issues for assessment by the Quality Management Program.
Engaging in multidisciplinary rounds specific to assigned units, addressing issues that affect discharge and length of stay promptly.
Conducting necessary reassessments and evaluating progress against care goals and plans, making adjustments as needed.
Collaborating with all members of the multidisciplinary team to support goals related to length of stay reduction and observation management.
Providing appropriate CMS documents to patients and their families/support persons in accordance with regulatory guidelines (e.g., Important Message 4 to 48 hours prior to discharge, appeal and HINN notices).
Maintaining annual competencies and completing training and continuing education in relevant platforms (Epic, Xsolis Cortex, Enterprise Analytics, Google Suites).
Complying with the Medical Center's Organization Competencies and Standards of Behavior.
Performing other duties as assigned.
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