Care Coordinator - Utilization & Discharge

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

Benefits offered by this job

Health benefits

Dental benefits

Vision benefits

Paid leave

Tuition reimbursement

Retirement benefits

Job summary

Hackensack Meridian Health seeks a Care Management, Care Coordinator, Utilization Management professional to coordinate, communicate, and facilitate the clinical progression of patients' treatment. Manage a designated caseload and ensure evidence-based care aligns with regulatory requirements and payer expectations in New Jersey.

The role requires RN licensure (NJ) with BSN preferred, strong decision-making and communication skills, and proficiency with Epic and related platforms.

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 admission review within 24 hours or the first business day.
• Collaborates with all members of the multidisciplinary team to support length of stay reduction and observation management goals.

Skills

Decision making

Verbal & written communication

Computer proficiency

Familiar with hospital resources

Education

BSN or BSN in progress

Tools

Epic

Xsolis Cortex

Enterprise Analytics

Google Suites

Job description

Hackensack Meridian Health seeks a Care Management, Care Coordinator, Utilization Management professional to coordinate, communicate, and facilitate the clinical progression of patients' treatment. Manage a designated caseload and ensure evidence-based care aligns with regulatory requirements and payer expectations in New Jersey.

The role requires RN licensure (NJ) with BSN preferred, strong decision-making and communication skills, and proficiency with Epic and related platforms.