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Hackensack Meridian Health · 1 day ago

UM Coordinator - Utilization Review - P/T with Benefits Days

Belle Mead, NJ

Part-time

Onsite

Senior Level

5+ years exp

Hackensack Meridian Health is dedicated to improving patient lives through a collaborative culture. The Utilization Management Coordinator will utilize clinical knowledge to review and coordinate care for patients, ensuring appropriate resource utilization and communication among treatment teams.

Assisted LivingHealth CareHealth DiagnosticsHospitalMedical

Responsibilities

Perform admission reviews to assure that the level of care criteria are met

In collaboration with the Access Center and Unit staff, assure that certification is completed at the earliest possible entry into the system, and recertification occurs timely

Perform concurrent reviews with third party payers and communicate potential or identified concerns to the treatment team, Director of Utilization Management, and the Medical Director

Review charts at identified review points and attend treatment planning conferences or team meetings, collecting data pertaining to clinical status and justifying the medical necessity for continued treatment in inpatient level of care. Referral of cases with questionable medical necessity to Physician Advisor for determination

Review clinical and diagnostic interventions for appropriateness and timeliness to achieve optimal clinical and financial patient outcomes

Participate in interdisciplinary team meetings as it relates to the following: insuring appropriate length of stay, reviewing treatment interventions, developing and implementing discharge plans

Collaborate with Patient Financial Services, Access Center and the clinical treatment team to insure optimal reimbursement for services provided

Review concurrent denials from third party payers with the interdisciplinary treatment team and orchestrate the appeal process where indicated

Anticipate patients' readiness for discharge and collaborate with primary therapists and discharge planners regarding transition to alternative levels of care

Perform concurrent utilization review applying identified criteria at prescribed review points, and retrospective focus reviews in concordance with department objectives

Perform all administrative tasks related to caseload such as Meditech documentation, continuity of care referral paperwork, team, committee, or special project reports, etc

Maintain competencies and professionalism by participating in educational opportunities with focus on case management, psychiatric and/or additional treatment issues/trends

Participate in the development and refinement of the Case Management Program

Participate in department and hospital committees

Other duties and/or projects as assigned

Adheres to HMH Organizational competencies and standards of behavior