Care Coordination & Utilization Specialist

Hackensack Meridian Health; Edison (NJ); On-site; USD 97,000 - 119,000; Full time

Benefits offered by this job

Health, Dental, Vision

Paid leave

Tuition reimbursement

Retirement benefits

Job summary

Hackensack Meridian Health in New Jersey is seeking a Care Management, Care Coordinator, Utilization Management to coordinate, communicate, and facilitate the clinical progression of patients' treatment. You will manage a designated caseload and ensure care meets evidence-based standards and regulatory requirements.

The role requires a BSN (or in progress within 3 years), NJ RN license, BLS, and strong decision-making, communication, and computer skills.

Qualifications

• BSN or BSN in progress and/or willing to acquire within 3 years of hire or transfer into the position.
• Effective decision-making skills, demonstration of creativity in problem-solving, and influential leadership skills.
• Excellent verbal, written and presentation skills.
• Moderate to expert computer skills.
• Familiar with hospital resources, community resources, and utilization management.

Responsibilities

• Follows departmental workflows for utilization review activities including admission reviews, admission denials, continued stay reviews, continued stay denials, termination of benefits, communication of information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews.
• Obtains and evaluates medical records for inpatient admissions to determine if required documentation is present.
• Obtains appropriate records as required by payer agencies and initiates physician advisor's review as necessary for unwarranted admissions.
• Performs chart reviews for appropriateness of admission and continued hospital stay applying appropriate clinical criteria.
• Performs appropriate reassessments and evaluates progress against care goals and the plan of care and revises plans, as needed.

Skills

Decision making

Problem solving

Leadership

Communication

Computer skills

Education

BSN or BSN in progress

NJ State Professional Registered Nurse License

AHA Basic Health Care Life Support (HCP) Certification

Job description

Hackensack Meridian Health in New Jersey is seeking a Care Management, Care Coordinator, Utilization Management to coordinate, communicate, and facilitate the clinical progression of patients' treatment. You will manage a designated caseload and ensure care meets evidence-based standards and regulatory requirements.

The role requires a BSN (or in progress within 3 years), NJ RN license, BLS, and strong decision-making, communication, and computer skills.