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UTILIZATION MGMT COORDINATOR

UTILIZATION MGMT COORDINATOR

ID 
2017-23757
Site 
BAYSHORE COMMUNITY HOSPITAL
Job Locations 
US-NJ-Holmdel
Status 
Full Time
Shift 
Day
Shift Hours 
8am - 4:30pm

More information about this job

Overview

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.

Responsibilities

Performs chart reviews for appropriateness of admission and continued hospital stay applying appropriate clinical criteria. Provides concurrent and retrospective clinical information to the insurance company within 24 hours or first business day of admission or request. Refers days for appeal to the physician advisor upon notification of denial. Documents identified avoidable, denied and alternate level of care days appropriately. Documents physician advisor’s response to referral, final determination and certification of hospital days. Demonstrates effective communication skills with physicians, patients and families, insurance companies, and all the disciplines through the continuum of care.

Qualifications

 

Active RN license

Case Management / Utilization Management experience preferred

At least 5 years of RN experience

CCM preferred

Good communication and interpersonal skills

 

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