Location: Edison, NJ
Cap-Exempt H-1B Position — No lottery required
Overview: 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 help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The **Care Management, Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of stay, promote efficient utilization of resources and ensure that care meets evidence-based practice standards and regulatory/payor requirements and follows the state of New Jersey regulations for Nursing. Responsibilities: A day in the life of a **Care Management, Care Coordinator, Utilization Management** at **Hackensack Meridian Health** includes: - Follows departmental workflows for utilization review activities including admission reviews, admission denials, continued stay reviews, continued stay denials, termination of benefits, communication of information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. - Obtains and evaluates medical records for inpatient admissions to determine if required documentation is present. - Obtains appropriate records as required by payer agencies and initiates physician advisor's review as necessary for unwarranted admissions. - Performs chart reviews for appropriateness of admission and continued hospital stay applying appropriate clinical criteria. Performs a