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UTILIZATION CARE COORDINATOR RN

UTILIZATION CARE COORDINATOR RN

ID 
2017-23059
Site 
OCEAN MEDICAL CENTER
Job Locations 
US-NJ-Brick
Status 
Per Diem
Shift 
Day
Shift Hours 
8:00A-4:30P

More information about this job

Overview

The UM Coordinator coordinates and monitors the daily utilization management function of the Care Management department, ensuring the appropriate allocation of hospital resources while maintaining quality of patient care. The UM Coordinator collaborates with the other members of the Care Management and multidisciplinary team to advocate for patients and families within the health care continuum. The UM Coordinator ensures regulatory compliance with CMS guidelines and coordinates medical management aspects of clinical review requests from numerous payer sources. The UM Coordinator assists in managing LOS and insuring documentation of medical necessity.

Responsibilities

  • Daily review of assigned cases to insure proper status and medical necessity
  • Written, electronic and phone correspondence with varied payers
  • Adherence to regulatory standards, including CMS guidelines
  • Communication with patients and families
  • Collaboration with multidisciplinary team during attendance at daily rounds
  • Data management, including LOS and progression of care review

Qualifications

Current NJ RN license

AAS in Nursing, BSN strongly preferred

Certified Case Manager preferred or required within 3 years

BLS certification or eligibility

2-3 years medical surgical, telemetry or ICU experience

Case management or UR experience preferred

Knowledge of Milliman Care Guidelines or Interqual preferred

Excellent written and verbal communication skills

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