Utilization Management Coordinator (RN, MSW, OT, PT)

Community LIFE; Pittsburgh (Allegheny County); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Paid Vacation (5 weeks)

Paid Holidays

403(b) retirement plan

Tuition Reimbursement

Mileage Reimbursement

Employee Appreciation events

Job summary

Community LIFE Pittsburgh seeks an Utilization Management Coordinator (RN/ MSW/ OT/ PT) to coordinate utilization management across care levels. Based in Forest Hills, you will collaborate with RN Case Managers to ensure appropriate care transitions and clinical decisions.

The role requires PA licensure with relevant health care experience. You will work in a multi-disciplinary setting within a Day Center-based program, coordinating authorizations and ensuring compliance with policies and

Qualifications

• Bachelor degree in Nursing (BSN) or equivalent with RN licensure in Pennsylvania
• Masters of Social Work (MSW)
• Valid PA Driver’s license
• Minimum 3 years in utilization review and discharge planning

Responsibilities

• Perform/utilization management across levels of care
• Coordinate with RN Case Managers for care goals
• Support hospital & nursing facility service authorization processes
• Collaborate with interdisciplinary teams across settings
• Address post-acute care needs and transitions

Skills

Utilization management

Interdisciplinary teamwork

Microsoft Office

Clinical data interpretation

Outlook

Education

Bachelor degree in Nursing (BSN) or equivalent

Bachelor degree in Physical Therapy (PT)

Associate degree in Physical Therapy (PTA)

Bachelor degree in Occupational Therapy (OT)

Associate degree in Occupational Therapy Assistant (COTA/L)

Master of Social Work (MSW)

Tools

Outlook

Word

PowerPoint

Excel

Job description

Utilization Management Coordinator (RN, MSW, OT, PT)

Community LIFE Pittsburgh, Pennsylvania, United States

About this position

Location: Covers all locations, based in Forest Hills (15221)

Schedule: 7:30am-4:00pm Mon-Fri

Summary of Job Duties: The Utilization Management Coordinator (UMC) is responsible to perform/coordinate utilization management functions across all levels of care. The UMC supports the established hospital & nursing facility service authorization process by adhering to the utilization management protocols and guidelines. In compliance with Community LIFE policies, industry standards, medical criteria and necessity, the UMC recommends and coordinates clinically sound and consistent level of care coverage decisions to assure the delivery of the “right care at the right time in the right location.” The UMC interprets clinical information provided or reviewed and works closely with RN Case Managers (RNCM) to ensure the participant goals of care are known to the health care providers across the continuum and at each transition of care. The individual who qualifies for this position will demonstrate experience across diverse healthcare settings, including skilled nursing facilities, community-based home care, outpatient clinics and hospital environments.

Required Education/Licensure combinations: One or more of the following is required

• Bachelor degree in Nursing (BSN) or an equivalent for a bachelor’s degree, with valid Registered Nurse (RN) licensure in Pennsylvania
• Bachelor degree in Physical Therapy with valid Physical Therapist (PT) Licensure in Pennsylvania
• Associate degree in Physical Therapy with valid Physical Therapist Assistant (PTA) Licensure in Pennsylvania
• Bachelor degree in Occupational Therapy with valid Occupational Therapist (OT) Licensure in Pennsylvania
• Associate degree in Occupational Therapy Assistant with valid Occupational Therapist (COTA/L) Assistant Licensure in Pennsylvania
• Masters of Social Work (MSW)

Additional Required Licensure: Valid PA Driver’s license

Required Experience: Minimum of 3 years in each of the below areas:

• Utilization review, utilization management, and/or insurance-based case management and authorization process.
• Discharge planning and coordination of post-acute care needs.
• Collaboration with interdisciplinary teams across clinical and community-based settings.
• Prior experience within a PACE program is preferred.

Required Knowledge, Skills & Abilities:

• Ability to interpret clinical information to support utilization protocols for authorizing inpatient services.
• Computer skills including Outlook, Word, PowerPoint and Excel.
• Self-organization skills; attentiveness to detail and accuracy.
• Knowledge of current acute and long-term care utilization standards.
• Ability to accept and utilize guidance.
• Ability to assess, address, and develop effective solutions for complex participant cases and care needs
• Ability to review clinical documentation, identify trends, recognize gaps in care, and evaluate participant needs to support appropriate utilization management decisions.
• Ability to apply clinical knowledge to assess participant care needs, determine medical necessity, and support appropriate levels of care and service authorization.
• Flexibility in responding to changes in departmental processes, regulatory requirements, participant needs, and daily workflow demands.
• Ability to effectively manage multiple high-priority cases, competing demands, and time-sensitive deadlines in a fast-paced environment.
• Ability to proactively identifies barriers, care gaps, and opportunities for process improvement while recommending appropriate interventions to support participant outcomes.
• Ability to respectfully and effectively interact with providers, case managers, and other members of the internal IDT for Community LIFE and outside vendors.
• Ability to compile and report data in a meaningful way.
• Acceptable physical and mental health to carry out the responsibilities of the position.

About us

Community LIFE is a program of all-inclusive care for the elderly, committed to empowering older adults to remain at home while preserving their dignity, independence and quality of life. Our program brings the region’s experts in geriatric medicine and care together to work as a team in specialized Day Centers, to help older adults enjoy the highest quality of life possible. Our professionals are committed to keeping older adults independent, and in their homes. Our wide range of services are designed to meet the varied needs of seniors, and include medical care, social services, meals, activities, transportation and much more.

Benefits

• Community LIFE offers a generous benefit package, including Medical, Dental and Vision insurance, Life insurance, Disability insurance, 5 weeks Paid Vacation, Paid Holidays, 403(b) retirement plan, Tuition Reimbursement, Mileage Reimbursement, Employee Appreciation events, and more!