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Posted: Friday, October 6, 2017 7:55 AM

The Utilization Management Coordinator, in collaboration with other Care Management staff, medical staff, ancillary departments, nursing and all appropriate members of the healthcare team will use professional clinical skills to evaluate opportunities to optimize clinical resource management, utilization of services, and proactively participate in activities to improve revenue cycle management, length of stay and resource utilization. The role of the Utilization Management Coordinator will include, but is not limited to; coordinating and monitoring the provision of care processes to optimize quality of care, patient satisfaction, utilization, cost, pre-admission, admission, concurrent, discharge, and retrospective reviews to ensure medical necessity, assertive application of utilization management strategies to avoid potential denials, and to ensure compliance with federal and state regulations.

Performs pre-admission, admission, concurrent stay, discharge and retrospective reviews based on established criteria and sound clinical knowledge for the purpose of ensuring medical necessity and appropriateness of services provided.

Identifies opportunities for improving clinical resource management and initiates activities to implement the opportunities .

Fosters cordial, positive and professional interpersonal relationships with patients, family members, physicians, members of the healthcare team, insurance companies, community agencies and peers .

Educates medical staff as appropriate regarding observation versus inpatient status, medical necessity and required medical record documentation .

Contributes to department and hospital and hospital Quality and Improvement initiatives .

Minimum Position Qualifications: List the following qualifications required for this position:

Registered Nurse with a current California license form an accredited school of Nursing including e xperience performing utilization management activities.

Three to five years of clinical experience.

Preferred Position Qualifications:

B.S.N. preferred.

UR, URAC, CCM certification preferred upon hire or within one year.

Experience in performing utilization management.

Prior experience with appeals and/or audits.


The people of St. Joseph Health have worked for 53 years to improve health and quality of life in California's North Bay region, starting in Sonoma County, where the Sisters of St. Joseph of Orange opened the doors of Santa Rosa Memorial Hospital in 1950. Today, we continue the mission begun by the Sisters and continued through the St. Joseph Health Ministry of extending the healing ministry of Jesus to those we serve through an integrated spectrum of primary, urgent, acute, outpatient, palliative care and regional referral services. Sonoma County entities aligned with St. Joseph Health include the 278-bed Santa Rosa Memorial Hospital, the region's only Level II trauma center, as well as the 80-bed Petaluma Valley Hospital. Our services also encompass three Urgent Care centers, Hospice of Petaluma, Memorial Hospice and North County Hospice, the Annadel Medical Group, as well as the St. Joseph Home Care Network. We act as a regional referral hub for outlying hospitals, while also providing outpatient behavioral health care, education to promote health and prevent chronic disease, rehabilitation, oral health care, community benefit programs, and more, all fostering health and quality of life throughout the area.

St. Joseph Health provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, St. Joseph Health complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training..

Positions specified as on call/per diem refers to employment consisting of shifts scheduled on as as needed basis to fill in for staff vacancies.

Associated topics: care, ccu, coronary, infusion, intensive care, maternal, nurse rn, psychatric, recovery, unit


• Location: North Bay, Santa Rosa

• Post ID: 83994412 northbay is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2017