Care Coordination Specialist

3 days ago

Detroit, Michigan, United States McLaren USA Full time
Job Summary

We are seeking a highly skilled and detail-oriented Care Coordination Specialist to join our team at McLaren USA. In this role, you will be responsible for providing critical support to our Utilization Manager (UM) RN in the coordination of patient admission and continued stay reviews.

Key Responsibilities
  1. Collaborate with the UM RN to determine the appropriate hospital setting (inpatient vs. observation) based on medical necessity.
  2. Perform concurrent and retrospective utilization management-related activities and functions to ensure that appropriate data are tracked, evaluated, and reported.
  3. Communicate clinical information with payors via phone, fax, and computer system per payer contract to obtain authorization for appropriate level of care and length of stay as needed.
  4. Obtain authorization for admission / concurrent stay for designated units.
  5. Provide prompt feedback regarding payor determinations to UM RN.
  6. Attend meetings and prepare agendas and minutes.
  7. Handle incoming and outgoing office correspondence; answer and direct department phone calls as needed.
  8. Perform general office duties including faxing, copying, scanning, and filing. Order department supplies.
  9. Communicate with internal and external customers to answer questions.
  10. Troubleshoot problems that arise with office equipment. Notify leadership of unresolved issues.
Requirements
  • Associate degree in a healthcare-related field.
  • Two years of clerical experience.
  • One-year experience in a healthcare environment utilizing medical terminology or have completed a college-level course in medical terminology.
Preferred Qualifications
  • Bachelor's degree in coding/medical records/billing or healthcare-related field.
  • Two years of case management or utilization review, billing, or coding experience.
  • Three years of recent experience doing third-party payer certification.
  • Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross, or equivalent through the Military Training Network (MTN).
Knowledge, Skills, and Abilities
  • Ability to handle multiple tasks and complete work within short timeframes.
  • Ability to understand, interpret, explain, and use data for case management activities.
  • Ability to work with diverse teams and individuals, team player.
  • Able to spend majority of time utilizing a computer, monitor, keyboard, and mouse; ability to type.
  • Competency in applying the principles, methods, materials, and equipment necessary in providing utilization management services.
  • Demonstrated expertise in utilization management principles, methods, and tools and incorporating them into the daily operations of the organization.
  • Excellent time management and organization skills.
  • Knowledge of care delivery systems across the continuum of care including, but not limited to, trends and issues in care reimbursement, medical necessity, and assigning level of care assignment (inpt vs obs).
  • Must be able to act calmly and effectively in busy/stressful environment.
  • Must be able to work independently, and utilize problem-solving techniques and critical thinking skills.
  • Proficient with Microsoft Office (i.e., Word, Excel, Outlook, and PowerPoint).
  • Strong verbal and written communication skills: ability to interact productively with leaders, peers, and customers.
  • Must be able to travel to subsidiaries or corporate meetings as needed.
  • Weekend, holiday, and evening coverage as per site requirements.

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