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Care Coordinator, Utilization Management -RN-Per Diem
Hackensack Meridian Health | |
United States, New Jersey, Holmdel | |
April 26, 2024 | |
Overview Our team members are the heart of what makes us better. At Hackensack MeridianHealth we help our patients live better, healthier lives - and we help one another tosucceed. With a culture rooted in connection and collaboration, our employees areteam members. Here, competitive benefits are just the beginning. It's also about howwe support one another and how we show up for our community. Together, we keepgetting better - advancing our mission to transform healthcare and serve as a leader ofpositive change. The Utilization Management Coordinator coordinates and monitors daily activities of the utilization management functions of the Care Coordination Department, ensuring the appropriate allocation of hospital resources while maintaining quality of patient care. This position also holds the responsibility for ensuring regulatory compliance requirements and coordinating the medical management aspects of clinical review requests from external entities. The Utilization Management Coordinator serves as a functional expert and liaison to Care Coordinator Staff and other departments within the hospital system. The UM Coordinator assists to develop consistent processes and enhance workflow of the concurrent review process with third party payers. The UM Coordinator oversees and facilitates medical necessity appeals as the result of concurrent denials. The UM Coordinator functions as the PRO Liaison facilitating the review process for Hospital Issued Notices of Non-Coverage (HINN's) and discharge reviews as they relate to Care Coordinator activities and directing PRO correspondence and cost outliers to the appropriate internal department. Provides Care Coordination Support as needed. Responsibilities A day in the life of a Utilization Management Coordinator at Hackensack Meridian Health includes: Admission Classification:
Education:
Meetings and Committee Participation:
Physician Documentation:
Resource Management:
Reviews:
Utilization Management:
Other duties and/or projects as assigned. 10. Adheres to HMH Organizational competencies and standards of behavior. Qualifications Education, Knowledge, Skills and Abilities Required:
Education, Knowledge, Skills and Abilities Preferred:
Licenses and Certifications Required:
Our Network Hackensack Meridian Health (HMH) is a Mandatory Influenza Vaccination Facility As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience. |