Care Facilitator- St. Lawrence Region
Core
Plans care delivery and coordinates across the continuum to ensure optimal patient outcomes and efficient resource utilization.
Role type
Senior Case Management Nurse (Utilization Management)
Builds
Patient care plans and discharge pathways
Domain
Healthcare / Utilization Management
Required skills
Clinical review, discharge planning, care coordination, payer requirements analysis, utilization management, data analysis, stakeholder communication, regulatory compliance, conflict resolution, process improvement
Preferred skills
Case management experience, utilization management experience, Bachelor's Degree
Technologies
Interqual, Care Management Database
Responsibilities
Conduct clinical reviews to assign level of care and identify required resources; Document level of care and medical necessity; Monitor resource utilization and manage length of stay; Refer cases to Review Physician Advisor for validation; Communicate clinical information and severity of illness to payors; Perform retrospective reviews on insurance denials and assist in appeals; Participate in daily huddles to address complex clinical issues; Utilize data and trends to improve processes.
Seniority
Mid-Senior level, hands-on IC
