Inpatient Coordinator
Position Summary: The Inpatient Coordinator supports the Utilization Management (UM) Inpatient Nurse Case Managers in the coordination and oversight of inpatient services for members. This role is responsible for facilitating timely case review, ensuring accurate documentation, supporting authorization processes, and maintaining compliance with regulatory and organizational turnaround time (TAT) requirements. The Inpatient Coordinator serves as a key liaison between hospitals, providers, and internal departments to promote efficient communication and continuity of care.
Essential Position Functions/Responsibilities:
- Assist Inpatient Nurse Case Managers with monitoring active inpatient cases to ensure timely review and determination.
- Open and maintain hospital cases in qHMO and other internal systems as needed.
- Monitor daily hospital census/logs to identify new admissions, open cases, discrepancies, and length-of-stay outliers.
- Verify patient admission source, level of care, and discharge disposition.
- Update cases upon discharge, including accurate documentation of discharge status and follow-up needs.
- Filter and review TAT reports to support nurses in meeting regulatory and internal timeliness standards.
- Monitor receipt of initial, concurrent, and discharge clinical documentation from facilities.
- Request initial, updated, and discharge clinical information from hospitals and providers.
- Verify eligibility and benefits through internal systems, including primary and secondary insurance coverage.
- Confirm and validate EZ-Cap authorizations for accuracy and completeness.
- Build and process authorizations for home care services, DME, acute transfers, or post-acute services as directed.
- Process denial determinations via the MDI tool in accordance with policy.
- Generate and issue Letters of Intent (LOI) and denial notifications within required timeframes.
- Forward cases requiring Medical Director review and ensure determinations are completed within compliance standards.
- Complete required verbal and written notifications to members and providers within regulatory timeframes.
- Establish and maintain professional working relationships with hospital case management, utilization review departments, and provider offices to ensure timely exchange of clinical information.
- Contact hospitals to confirm member admissions, continued stays, and discharge planning details.
- Respond to intake clarification requests and coordinate with internal departments as needed.
- Serve as a non-clinical resource to Inpatient Nurse Case Managers to support workflow efficiency.
- Identify gaps in documentation or process and escalate issues appropriately.
- Support audit readiness by ensuring accurate and complete case documentation.
Skills, Knowledge, Abilities
- Demonstrated ability to manage multiple priorities in a fast-paced, deadline-driven environment.
- Strong understanding of medical terminology and inpatient care processes.
- Working knowledge of ICD-10 and CPT coding.
- Excellent verbal and written communication skills.
- Strong organizational skills and attention to detail.
- Ability to work independently while functioning as a collaborative team member.
- Proficiency in Microsoft Office Suite, including Word and Excel.
- Experience working within managed care platforms (e.g., qHMO, EZ-Cap, MDI) preferred.
- Knowledge of regulatory compliance standards related to utilization management and health plan operations.
- High School Diploma or equivalent required.
- Certified Medical Assistant (CMA) or Associate’s Degree preferred.
- Additional coursework or certification in healthcare administration, medical coding, or managed care is a plus.
- Minimum of 3–5 years of clinical or healthcare administrative experience required.
- Prior experience in Managed Care, Utilization Management, or Health Plan operations strongly preferred.
- Experience working with inpatient hospital systems or care management departments preferred.
Recommended Jobs
IVR Specialist
: ~ ADMIN FOR CHILDREN'S SVCS Posted On: 05/24/2025 ~ Full-Time Location MANHATTAN ~ Exam May Be Required Department Mis Admin,Network Sysms Dvlpmt Salary Range: $81,784.00 - $1…
Laundry Attendant/Driver
$16-$18 hourly depending on experience. INNS OF AURORA, LLC CORE VALUES: While our employees’ skill-sets vary greatly from position to position, our core set of values remain the same. As an I…
MRI Technologist - Outpatient Imaging
Syracuse, NY Full-Time | Monday–Friday, 8:30 AM–5:00 PM $38.60 – $53.00/hr ($80,288 – $110,240 annually) The Opportunity A busy outpatient imaging department in Syracuse, NY is addi…
Fitness Team Member! Sales Team
AF is looking for a responsible Gym Attendant Team Members to take care of our Health Clubs; carry out cleaning, maintenance, and office duties. The goal is to keep our gyms exceptionally clean, organ…
Property Manager
Property Manager Join a Growing Apartment Rental Company We are seeking an experienced and driven Property Manager to join our expanding team. This is an exciting opportunity to work with a …
Entry-Level Virtual Policy Consultant
Career Opportunity – Work From Anywhere AO is actively seeking driven, ambitious professionals ready to step into leadership and grow with a high-performing organization. If you take pride in bui…
Income Building Specialist (Brooklyn, 11234)
Job Description Job Description Title of Position: Income Building Specialist FLSA Status: Non-Exempt Department: Program Support Services Salary: $27.55/ hr. Reports to: Manager, In…
Engagement Coordinator
HomeGoods At TJX Companies, every day brings new opportunities for growth, exploration, and achievement. You’ll be part of our vibrant team that embraces diversity, fosters collaboration, and priorit…
Senior Accountant
Department: Finance and Administration Type of Position: Full Time Monday – Friday | Hybrid with 2 days in person Location: 111 John Street, Suite 770, New York, NY 10038 Position Description: Hab…
Strategic Change Manager, Assistant Vice President
Strategic Change Manager - Assistant Vice President Wealth Management Platforms Location: Purchase Morgan Stanley is a leading global financial services firm providing a wide range of inve…