Utilization Mgmt Coordinator F/T Day


BAYSHORE MEDICAL CENTER Holmdel Requisition # 2021-91329 ShiftDay StatusFull Time with Benefits Weekend WorkWeekends as Needed HolidaysAs Needed On CallNo On-Call Required Shift HoursDay Address727 North Beers Street, Holmdel, 07733

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Overview

How have you impacted someone's life today? At Hackensack Meridian Health our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career, all within New Jersey's premier healthcare system.

Responsibilities

Monitors the daily utilization functions of the Care Management department insuring the appropriate allocation of resources while maintaining quality care. The UM Coordinator collaborates with the multidisciplinary team and Care Management department to AdvoCare for patients and families within the health care continuum.  The UM Coordinator insures regulatory compliance with CMS and DOH guidelines and coordinates clinical review requests from payer sources.

  • Conducts daily review of assigned cases to insure proper status, medical necessity for admission and continued stay
  • Written, electronic and phone correspondence with payers
  • Adherence to regulatory standards
  • Data management, including LOS and progression of care review
  • Collaboration with multidisciplinary team members

Qualifications

  • Current NJ nursing license
  • BSN and national certification preferred
  • American Heart Association BLS/CPR
  • 3-5 years acute care experience, preferable medical/surgical, telemetry or ICU required
  • Prior experience in case management, discharge planning, utilization review preferred
  • Certified in case management or eligibility within 3 years
  • Excellent written and verbal communication skills
  • Knowledge of Milliman or Interqual criteria desirable

Our Network

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.