Care Coordinator & Utilization Manager

St. Lawrence Health; Village of Potsdam (NY); On-site; USD 70,000 - 95,000; Full time

Job summary

Rochester Regional Health is seeking a Care Facilitator in Canton-Potsdam Hospital to coordinate patient care across the continuum. You will support utilization management, discharge planning and referrals while collaborating with the health care team to ensure timely, efficient care delivery.

The role requires NYS RN licensure and an accredited nursing degree, with recent hospital experience preferred. Excellent communication and payer coordination are essential in this position.

Qualifications

• Active New York State Registered Nurse license required.
• Diploma from accredited nursing school or Associate's Degree in nursing.
• For hires after 10/28/2024, 3 years acute hospital care experience required.

Responsibilities

• Conduct clinical reviews using InterQual criteria to assign level of care.
• Document level of care and medical necessity in the Care Management database.
• Monitor resource utilization and perform continued stay reviews across the continuum.
• Refer cases to the Review Physician Advisor for validation of level of care.
• Serve as a resource on payer requirements and coordination with payors.
• Communicate clinical information to payors regarding illness severity and plan of care.
• Participate in daily huddles to address complex clinical issues and barriers.
• Use data and reports to identify opportunities to improve processes.

Education

NYS RN License

Nursing Diploma or Associate Degree

Job description

Rochester Regional Health is seeking a Care Facilitator in Canton-Potsdam Hospital to coordinate patient care across the continuum. You will support utilization management, discharge planning and referrals while collaborating with the health care team to ensure timely, efficient care delivery.

The role requires NYS RN licensure and an accredited nursing degree, with recent hospital experience preferred. Excellent communication and payer coordination are essential in this position.