Care Coordinator, Utilization Management - job 2 of 2

As a Care Coordinator in Utilization Management at Hackensack Meridian Health, you will be responsible for managing a designated patient caseload, coordinating the clinical progression of treatment, and ensuring care meets regulatory and evidence-based criteria. Your key responsibilities will include conducting utilization reviews, obtaining and evaluating medical records for admissions, performing chart reviews for hospital stay appropriateness, collaborating with a multidisciplinary team, and identifying quality issues for the Quality Management Program.

To qualify for the Care Coordinator, Utilization Management position at Hackensack Meridian Health, candidates must possess a BSN or be actively pursuing one and must have a valid NJ State Professional Registered Nurse License. Additional certifications like Certified Case Manager (CCM) or similar are preferred, along with strong decision-making skills, excellent communication abilities, and proficiency in computer systems.

The Care Coordinator in Utilization Management at Hackensack Meridian Health plays a vital role in enhancing patient care by facilitating efficient treatment pathways. By reviewing admissions and current patient statuses, coordinating with healthcare teams, and executing care plans based on clinical criteria, the Care Coordinator helps prevent unnecessary hospital stays and ensures patients receive the right care at the right time.

Training and competencies for a Care Coordinator at Hackensack Meridian Health include maintaining knowledge in critical platforms like Epic and Xsolis Cortex, completing annual competencies, and participating in ongoing education. This training ensures that Care Coordinators remain updated with the latest practices and regulatory changes impacting patient care and utilization management.

Care Coordinators at Hackensack Meridian Health can expect a collaborative and supportive work environment that promotes personal and professional growth. The organization fosters teamwork, encourages participation in committees and meetings, and provides opportunities to engage in community health initiatives, all while offering competitive benefits and resources.

When answering this question, highlight specific experiences related to utilization reviews, emphasizing your ability to thoroughly assess medical records and coordinate with healthcare professionals to meet regulatory standards. Use examples that showcase your analytical skills and decision-making in real-world scenarios.

In response to this question, discuss your approach to handling disputes, including gathering necessary documentation, communicating effectively with insurance companies, and utilizing data to advocate for your patients. Provide examples of successful resolutions to past disputes.

Elaborate on techniques you employ to foster effective collaboration, such as scheduling regular meetings, using clear communication tools, and ensuring that all team members are aligned on the patient’s goals. Be ready to discuss a specific instance where collaboration led to improved patient outcomes.

When addressing this question, explain your systematic approach to evaluating care plans, including regular reassessment, setting measurable goals, and collaboratively adjusting plans based on patient feedback and clinical outcomes. Illustrate with examples of how you have successfully altered care plans.

Highlight qualities such as strong communication skills, attention to detail, ability to solve problems creatively, and a passion for patient advocacy. Use examples from your experience to illustrate why these qualities are crucial for success in the Care Coordinator role.

Discuss the methods you use to stay informed about healthcare regulations, including attending workshops, participating in professional associations, and conducting independent research. Mention how you’ve applied your knowledge of these regulations in your previous roles.

Focus on a specific challenging case and outline the steps you took to manage it, including how you involved other team members and what outcomes were achieved. This will demonstrate your problem-solving abilities and resilience in difficult situations.

Emphasize the importance of data analysis in identifying trends, monitoring patient outcomes, and implementing quality improvements. Provide an example of how data analysis led to a positive change in your previous work.

Discuss your communication style and methods for providing education, ensuring that it's clear and accessible. Highlight any tools or resources you use to engage patients and families effectively and how you assess their understanding.

When answering, detail your organizational methods, such as creating to-do lists, setting deadlines, and using scheduling tools. Explain how you balance urgent needs with long-term goals, using examples from your experience to support your response.