Care Coordination & Utilization Specialist

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

Job summary

Hackensack Meridian Health in New Jersey is seeking a Care Management, Care Coordinator, Utilization Management to oversee the clinical progression of patient treatment within a designated caseload and ensure care meets regulatory and payor requirements.

You will review records, collaborate with multidisciplinary teams, and participate in committees to support length of stay reduction and discharge planning. A BSN and NJ RN license are required, with certifications preferred.

Qualifications

• BSN or BSN in progress and/or willing to acquire within 3 years of hire.
• NJ RN license required and current CPR/BLS certification.
• Familiar with utilization management processes and hospital resources.

Responsibilities

• Follows departmental workflows for utilization review activities including admission reviews and denials.
• Obtains and evaluates medical records for inpatient admissions to determine documentation completeness.
• Performs chart reviews for appropriateness of admission and length of stay using clinical criteria.
• Collaborates with physician advisor and multidisciplinary team to manage care plans.
• Participates in committees and rounds to support discharge planning and bed management.
• Maintains competencies and completes ongoing training in relevant platforms.

Skills

Decision-making

Communication skills

Computer skills

Familiar with hospital resources

Education

BSN or BSN in progress

NJ State Professional Registered Nurse License

AHA Basic Health Care Life Support (BLS) Certification

Job description

Hackensack Meridian Health in New Jersey is seeking a Care Management, Care Coordinator, Utilization Management to oversee the clinical progression of patient treatment within a designated caseload and ensure care meets regulatory and payor requirements.

You will review records, collaborate with multidisciplinary teams, and participate in committees to support length of stay reduction and discharge planning. A BSN and NJ RN license are required, with certifications preferred.