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Utilization Review/Management Coordinator

2 months ago

New York, New York, United States NYC Health Hospitals Full time
Job Summary

We are seeking a highly skilled Utilization Review/Management Coordinator to join our team at NYC Health + Hospitals. The successful candidate will play a critical role in ensuring the efficient and effective delivery of healthcare services to our patients.

Key Responsibilities
  • Conduct thorough reviews of patient medical records to determine medical necessity and appropriateness of hospitalization
  • Abstract and analyze clinical information to identify areas for improvement in patient care and services
  • Collaborate with healthcare teams to develop and implement plans to enhance patient throughput and flow
  • Communicate with managed care companies to obtain authorization for required services and ensure timely certification
  • Provide coverage and certification information to other disciplines as needed
  • Monitor patient progress and make recommendations for level of care based on established guidelines
  • Complete and assign accommodation codes for patients on ALOC in EPIC
  • Conduct focused reviews and collect data to prepare and submit timely and accurate reports
  • Assure completeness of medical records for submission to quality improvement organizations
  • Notify the Physician Advisor of cases that do not meet criteria in a timely manner
Requirements
  • Graduate of an accredited medical program or New York State professional nursing licensure (R.N.)
  • Two years of experience in a hospital clinical setting or one year of experience in utilization/quality management
  • Satisfactory equivalent experience
What We Offer
  • Comprehensive health benefits for employees hired to work 20+ hours per week
  • Retirement savings and pension plans
  • Loan forgiveness programs for eligible employees
  • Paid holidays and vacation in accordance with employees' collectively bargained contracts
  • College tuition discounts and professional development opportunities
  • Multiple employee discounts programs