UM Coordinator

Job Title: Utilization Management Coordinator

At Hackensack Meridian Health, our team members are the heart of what makes us better. We help our patients live better, healthier lives and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members who support each other and show up for their community.

The Utilization Management Coordinator plays a crucial role in reviewing and coordinating care for a designated patient caseload. They collaborate with the treatment team, including attending physicians, clinical case managers, nurses, and other healthcare professionals, as well as staff from the ACCESS center and Patient Financial Services department. This ensures that resources and benefits are utilized appropriately on a case-by-case basis.

Main Responsibilities:

• Perform admission reviews to ensure that level of care criteria are met.
• In collaboration with the Access Center and Unit staff, complete certification at the earliest possible entry into the system, and recertification occurs timely.
• Conduct concurrent reviews with third-party payers and communicate potential or identified concerns to the treatment team, Director of Utilization Management, and 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 an inpatient level of care.
• Refer cases with questionable medical necessity to a 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 to ensure appropriate length of stay, review treatment interventions, and develop and implement discharge plans.
• Collaborate with Patient Financial Services, Access Center, and the clinical treatment team to ensure 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.
• Conduct 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 the caseload, such as Meditech documentation, continuity of care referral paperwork, team, committee, or special project reports.
• Maintain competencies and professionalism by participating in educational opportunities focused 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.

Requirements:

• RN, BSN, or Bachelor's degree in a clinical field with a healthcare focus.
• Minimum five years of clinical experience in a behavioral health care setting.
• Excellent written and verbal communication skills.
• Proficient computer skills, including Microsoft Office and/or Google Suite platforms.

PREFERRED QUALIFICATIONS:

• Master's Degree.

LICENSURES AND CERTIFICATIONS PREFERRED:

• NJ State Professional Registered Nurse License or NJ Licensed Social Worker.