Hackensack Meridian Health
Care Management, Care Coordinator, Utilization Management
Hackensack Meridian Health, Hackensack, New Jersey, us, 07601
Join to apply for the
Care Management, Care Coordinator, Utilization Management
role at
Hackensack Meridian Health . Our team members are the heart of what makes us better. At
Hackensack Meridian
Health
, we help our patients live better, healthier lives — and we support one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. We offer competitive benefits and a supportive environment that emphasizes community impact. The
Care Management, Care Coordinator, Utilization Management
is part of the healthcare team, responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment. This role manages a designated patient caseload, plans effectively to manage length of stay, promotes efficient resource utilization, and ensures care meets evidence-based standards, regulatory, and payor requirements, including New Jersey nursing regulations. Responsibilities
Follow departmental workflows for utilization review activities such as admission reviews, denials, continued stay reviews, and retrospective reviews. Obtain and evaluate medical records for inpatient admissions to verify documentation. Coordinate with payers and physicians for reviews and approvals of admissions and stays. Perform clinical chart reviews within 24 hours or the first business day. Refer cases not meeting criteria to physician advisors or designated vendors. Participate in committees, workgroups, and multidisciplinary rounds. Identify and escalate quality issues for review. Support discharge planning and length of stay reduction efforts. Provide CMS documentation to patients and families as per regulations. Maintain competencies and complete ongoing training (Epic, Xsolis Cortex, Enterprise Analytics, Google Suites). Adhere to organizational standards and behaviors. Perform other duties as assigned. Qualifications
Education, Knowledge, Skills, and Abilities : BSN or in progress, willing to acquire within 3 years. Effective decision-making, problem-solving, and leadership skills. Excellent communication skills. Moderate to advanced computer skills. Familiarity with hospital and community resources, utilization management. Licenses and Certifications : NJ State Registered Nurse License. AHA Basic Life Support (BLS) certification. Preferred Certifications : Certified Case Manager (CCM), Certified Clinical Medical Assistant (CCMA), or ACMA certification preferred. If you believe you are a good fit, please apply today! We are committed to pay equity and transparency. The posted salary range is an estimate of the minimum base pay at the time of posting and does not reflect the full value of our total rewards package.
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Care Management, Care Coordinator, Utilization Management
role at
Hackensack Meridian Health . Our team members are the heart of what makes us better. At
Hackensack Meridian
Health
, we help our patients live better, healthier lives — and we support one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. We offer competitive benefits and a supportive environment that emphasizes community impact. The
Care Management, Care Coordinator, Utilization Management
is part of the healthcare team, responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment. This role manages a designated patient caseload, plans effectively to manage length of stay, promotes efficient resource utilization, and ensures care meets evidence-based standards, regulatory, and payor requirements, including New Jersey nursing regulations. Responsibilities
Follow departmental workflows for utilization review activities such as admission reviews, denials, continued stay reviews, and retrospective reviews. Obtain and evaluate medical records for inpatient admissions to verify documentation. Coordinate with payers and physicians for reviews and approvals of admissions and stays. Perform clinical chart reviews within 24 hours or the first business day. Refer cases not meeting criteria to physician advisors or designated vendors. Participate in committees, workgroups, and multidisciplinary rounds. Identify and escalate quality issues for review. Support discharge planning and length of stay reduction efforts. Provide CMS documentation to patients and families as per regulations. Maintain competencies and complete ongoing training (Epic, Xsolis Cortex, Enterprise Analytics, Google Suites). Adhere to organizational standards and behaviors. Perform other duties as assigned. Qualifications
Education, Knowledge, Skills, and Abilities : BSN or in progress, willing to acquire within 3 years. Effective decision-making, problem-solving, and leadership skills. Excellent communication skills. Moderate to advanced computer skills. Familiarity with hospital and community resources, utilization management. Licenses and Certifications : NJ State Registered Nurse License. AHA Basic Life Support (BLS) certification. Preferred Certifications : Certified Case Manager (CCM), Certified Clinical Medical Assistant (CCMA), or ACMA certification preferred. If you believe you are a good fit, please apply today! We are committed to pay equity and transparency. The posted salary range is an estimate of the minimum base pay at the time of posting and does not reflect the full value of our total rewards package.
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