Regional Utilization & Care Coordination Lead

Oceans Healthcare, L.L.C.; Lafayette (LA); On-site; USD 55,000 - 85,000; Full time

Job summary

Oceans Healthcare, L.L.C. in Lafayette, LA is seeking a Regional Utilization Management Coordinator to supervise utilization review and case management across assigned inpatient facilities, including potential partial hospitalization and outpatient programs.

The role focuses on conducting concurrent chart reviews to confirm admission criteria, document level of care, and support timely discharge planning, while coordinating information between third party payers and medical staff.

Qualifications

• Experience with utilization review and case management in inpatient settings.
• Familiarity with Joint Commission, Federal and State regulations.
• Ability to coordinate payer communications and discharge planning.

Responsibilities

• Identify and report use patterns to ensure high quality patient care in the least restrictive, cost-effective settings.
• Review inpatient, IOP/partial hospitalization, and outpatient records for appropriateness, timeliness, and clinical necessity of admission, continued stay, and discharge.
• Notify staff of deficiencies and take corrective actions in a timely manner; submit monthly reports with findings.
• Coordinate flow of communication between physicians, staff and third-party payers regarding reimbursement requirements.
• Attend mini-treatment team and morning status meetings to gather third-party payer data for pre-certification and ongoing certification.
• Maintain abstracts with updates provided to third-party payers and respond to documentation requests.

Job description

Oceans Healthcare, L.L.C. in Lafayette, LA is seeking a Regional Utilization Management Coordinator to supervise utilization review and case management across assigned inpatient facilities, including potential partial hospitalization and outpatient programs.

The role focuses on conducting concurrent chart reviews to confirm admission criteria, document level of care, and support timely discharge planning, while coordinating information between third party payers and medical staff.