Coordinator - Utilization Management / Wyandotte (Contingent)
GENERAL SUMMARY:
Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. Combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments, problem identification and education facilitates the quality of health care delivery in the most cost effective manner. Performs other related duties as required.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Utilizes approved screening guidelines to evaluate the appropriateness of admission care, continuation of care and discharge screens.
- Serves as a principle link between Inpatient Case Management and third party payers, establishing relationships that positively impact financial outcomes.
- Identifies actual and potential problems throughout the hospitalization to improve the utilization of hospital resources through the appropriate action and/or recommendation. Analyze data as it pertains to the utilization of resources and quality and level of patient care.
- Reviews and provides medical information for those patients whose financial reimbursement to the hospital is dependent upon accurate information being provided to the appropriate government agencies and third party payers. Identifies inappropriate/inaccurate documentation that may potentially have legal and/or financial ramifications. Follows established guidelines for reporting issues.
- Facilitate/coordinate involvement of medical staff, when appropriate, in responding to third party payers requests’ to ensure positive outcomes and maximal reimbursement of hospital services.
- Plans and implements special studies needed to support administrative and medical decisions regarding health care policies, procedures and practices.
- Assists in the education of medical staff and other health care professionals regarding, utilization of resources and government regulations that impact the delivery of care.
- Communicates both written and verbally with third party payers to obtain necessary authorization for reimbursement of services.
- Performs other related duties as required.
EDUCATION/EXPERIENCE REQUIRED:
- Registered Nurse with a valid, unrestricted State of Michigan License.
- Minimum 3-5 years of clinical experience.
- Previous utilization management or case management experience, preferred.
- The ability to communicate with individuals from various socio-economic backgrounds regarding a variety of hospital-wide practices.
- Knowledge of outside regulatory agencies that interface with the institution.
CERTIFICATIONS/LICENSURES REQUIRED:
- Registered Nurse with a valid, unrestricted State of Michigan License.
Overview
Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health
care systems, is a national leader in clinical care, research and education. The system includes
the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health
insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory
network and many other health-related entities throughout southeast Michigan, providing a
full continuum of care. In 2015, Henry Ford provided $299 million in uncompensated care.
The health system also is a major economic driver in Michigan and employs more than 24,600
employees. Henry Ford is a 2011Malcolm Baldrige National Quality Award recipient. The
health system is led by President and CEO Wright Lassiter III. To learn more, visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. My Choice Rewards is a program as diverse as the people it serves. There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.