Utilization Mgmt Coordinator


BAYSHORE MEDICAL CENTER Holmdel Requisition # 2020-82618 ShiftDay StatusFull Time with Benefits Weekend WorkWeekends as Needed HolidaysAs Needed On CallOn-Call Commitment 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

The UM Coordinator monitors the daily utilization functions of the Care Management department, ensuring the appropriate allocation of resources while maintaining quality care for the behavioral health patient.  The UM Coordinator collaborates with other members of the behavioral health multidisciplinary team and Care Management department to advocate for patients and families within the health care continuum.  The UM Coordinator ensures regulatory compliance with CMS and DOH guidelines and coordinates clinical review requests from numerous payer sources.  Primary responsibility is with the behavioral health population with cross training to the medical-surgical inpatient areas.

 

Daily review of assigned cases to insure medical necessity for admission and continued stay

Written, electronic and telephonic correspondence with various payers

Adherence to regulatory standards

Communication with patients and families

Collaboration with multidisciplinary team members

Data management, including LOS and progression of care review

Qualifications

  • Current NJ RN license
  • 2-3 years medical-surgical, telemetry or ICU nursing experience required
  • BSN strongly preferred, required in 5 years
  • Behavioral health experience preferred
  • Certification in Case Management or eligibility in 3 years
  • BLS certification
  • Knowledge of Milliman Care Guidelines or Interqual preferred
  • Excellent written, verbal and telephonic communication skills

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.