The CAH Coordinator ensures coordination and compliance of the Hospital Quality Programs and Utilization Review Plan/Committee per CMS regulations. Evaluates the quality and medical necessity of patient care by using regulatory indicators and established parameters, generate reports, analyze data for trends and presents findings to the administration and providers. Participates and leads quality metrics and utilization review programs promoting patient safety and addressing improvement opportunities identified. Provides quality metrics and utilization of services education to staff and physicians. Develop and maintain physician performance reports. Review hospital medical necessity denials. government and commercial insurance claims, providing clinical appeals when indicated. Perform daily utilization review activities; medical necessity, status selection assistance/education.

Minimum Requirements:

1)Education: associate degree in nursing or related field requires (BSN Preferred)
2) Experience: Three years of experience in quality metrics, case management, discharge planning, utilization review, infection control or nursing project development/education required. Preferred experience with InterQual methodology, data analytics programs, CMS regulations, Meditech Expanse, RAC appeals and EHR Quality Integration. Prefer experience in Critical Access Hospital and swing bed regulations.
3) Licenses and Certifications: RN- Current State of Montana Required

Salary commensurate with up to 10 years of experience.

Health, dental, life, disability insurance and FLEX/HSA benefits available with 403-b option.

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Additional Information
Position Type : Full Time
Shift : Other
Ref Code: 2023-114

Contact Information
Employee Services
Employee Services
30 13th St
Havre, MT 59501
Email: nmhcempls@nmhcare.org
Phone: (406)262-1402
Fax: (406)262-1611