Care Facilitator

Job Title: Care Facilitator
Department: Utilization Review
Location: Unity Hospital
Hours Per Week: Full Time – 40 Hours
Schedule: Monday through Friday; Days; In-person.

SUMMARY:

Comprehensively plans with the health care team to ensure patient needs are met and care delivery is coordinated across the continuum. Identifies and works to eliminate/minimize system variation and service delivery barriers that prevent achievement of optimal patient outcomes in the expected time frame and with most efficient utilization of resources. Carries out activities related to utilization management, discharge planning, care coordination and referral to other levels of care. Performs as an integral part of the interdisciplinary team promoting interdisciplinary collaboration and champions service excellence. Facilitates assignment of level of care, considers payer requirements and responds accordingly to avoid adverse financial consequence to patient and hospital. Provide superior customer service by modeling the Brand Promise and Core Values.

RESPONSIBILITIES:

• Conducts clinical reviews using Interqual criteria to determine appropriate patient level of care, document medical necessity, and support reimbursement.

• Monitors resource utilization through continued stay reviews, manages length of stay, and coordinates with Physician Advisors for complex cases.

• Serves as a liaison between hospital and payors, ensuring accurate communication of clinical information, supporting appeals, and optimizing benefit use.

• Collaborates with care teams to resolve barriers to care, participates in daily huddles, and uses data to identify opportunities for process improvement.

REQUIRED QUALIFICATIONS:

• Diploma from an accredited nursing school program or Associate's Degree

• 3 years acute hospital care experience

• Licensed in New York State as a Registered Nurse

PREFERRED QUALIFICATIONS:

• Case Management or Utilization Management experience

• Bachelor’s Degree