Coordinator, Utilization Management - Full Time Days
: Job Details :

Long Island Community Hospital has served this richly diverse region as a patient-first community hospital for more than 60 years. As Long Island's only independent community hospital, we are 100% committed to becoming the community's healthcare provider of choice with our greatly enhanced services including the Knapp Cardiac Care Center, our highly-advanced heart disease diagnosis and treatment facility, our new modern surgical pavilion, our unique ER approach, and our high-touch services including women's imaging, sleep laboratory and orthopedics and more. These services are delivered with the highest level of compassion by our LI Community Hospital staff - Long Islanders with an unmistakable mix of courage and heart who care about the people right here in our community and whose sole purpose is to provide personalized comfort.For more information, go tolicommunityhospital.org, and interact with us onLinkedIn,Glassdoor,Indeed,Facebook,Twitter,YouTubeandInstagram.

Position Summary:We have an exciting opportunity to join our team as a Coordinator, Utilization Management - Full Time Days 9AM-5PM; Monday through Friday - Care ManagementIn this role, the successful candidate the UM Coordinator will work under the direction of the UM Manager and share responsibility for managing the functions of utilization management, observation services and CMS Code 44 reviews to ensure, based on patient assessment, that care is provided in the most appropriate setting utilizing medically indicated resources. The hospitals case management model outlines a collaborative practice to improve quality through coordination of care impacting length of stay, minimizing cost, and ensuring optimum outcomes. This position will require flexibility in assignments and scheduling and will cover for the UM Manager in their absence. The UM Coordinator assures compliance with CMS Conditions of Participation regarding Utilization Management, Observation service and Medicare short stays and assists with the coordination of the Utilization Management Committee. The UM Coordinator is also responsible for ensuring compliance with all regulatory agency provisions of care regarding appropriate patient level of care. The position also requires working knowledge and experience with medical necessity criteria such as MCG guidelines.

Job Responsibilities:

• Promote the mission, vision, and values of the organization.
• Facilitate team meetings that foster interdepartmental collaboration with the Case Managers and Social workers as necessary.
• Participate in multidisciplinary meetings and UMC/POC meetings.
• Evaluate and screen potential admissions to the facility.
• Ensure compliance with all regulatory agency provisions of care regarding appropriate patient level of care.
• Utilize MCG/InterQual criteria to determine Medicare, Medicaid, HMO and private insurance coverage.
• Communicate daily with admissions personnel regarding admissions and discharges to various units.
• Cooperate with insurance companies, based on information received.
• Maintain or surpass the UM System by collecting quality indicators and variance data, reporting the data to the appropriate department.
• Report and identify data indicating potential areas for improvement of care and services provided within the system.
• Educate physicians and staff regarding appropriate level of care/utilization issues.
• Develop and implement methods, policies and procedures to improve departmentemental efficiency and overall effectiveness.
• Maintain confidentiality of all patient, medical, financial, and legal information.
• Cover for the UM Manager in their absence as needed.

Minimum Qualifications:To qualify you must have a Registered nurse (RN) with minimum 3 years acute hospital nursing experience requiredBachelor's degree required. Knowledge of medical necessity criteria for Medicare, Medicaid, HMO and private insurance coverage.Able to oversee the utilization management process for the medical centerGood interpersonal skills demonstrable in interactions with staff, administrators, physicians and payersRequires a relatively high level of analytical skill necessary to assess patients needs, and determine the appropriate setting of care Knowledge of services required and insurance coverage Strong organizational skillsAbility to determine appropriate course of action in more complex situationsAbility to work independently, exercise creativity, be attentive to detail, and maintain a positive attitudeAbility to manage multiple and simultaneous responsibilities and to prioritize scheduling of workAbility to maintain confidentiality of all medical, financial, and legal informationAbility to complete work assignments accurately and in a timely mannerAbility to communicate effectively, both orally and in writingAbility to handle difficult situations involving patients, physicians, or others in a professional mannerKnowledge of the continuum of care and utilization process.. Required Licenses: Registered Nurse License-NYS

Preferred Qualifications:one (1) to three (3) years acute hospital Case Management / Utilization experience strongly preferred.

Qualified candidates must be able to effectively communicate with all levels of the organization.Long Island Community Hospital provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.Long Island Community Hospital is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online. If you wish to view Long Island Community Hospital's EEO policies, please click here. Please click here to view the Federal EEO is the law poster or visit for more information.

Long Island Community Hospital provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $79,310.00 - $134,157.50 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

To view the Pay Transparency Notice, please click here