Utilization Management, Care Coordination, & Community Benefit Coordinator (RN)

JOB SUMMARY

Responsible for utilization management, care coordination, Swing Bed oversight, SDoH integration, community benefit activities, and supervision of assigned staff. Partners with the hospital social worker and Geriatric Behavioral Health Program Director (non-supervisory). Functions as a loop closer across Patient Access, Revenue Cycle, and HIM to ensure accurate communication, documentation, and task completion.

 ROLES AND RESPONSIBILITIES

1. Supervision & Department Leadership

• Supervises assigned Case Management, UR, and/or Swing Bed staff.
• Provides coaching, education, task delegation, and performance feedback.
• Ensures team compliance with CMS CAH regulations and internal policies.

2. Utilization Management

• Performs admission, continued stay, and discharge reviews using CMS CAH guidelines.
• Ensures documentation supports medical necessity and correct patient status.
• Educates physicians and APPs on documentation requirements and regulatory criteria.
• Coordinates payer authorizations and prevents avoidable denials.
• Tracks and reports UM trends (LOS, denials, avoidable days, transfers).

3. Care Coordination

Emergency Department

• Conducts SDoH and resource assessments.
• Coordinates safe discharges, transfers, follow-up appointments, and community referrals.
• Supports behavioral health placement and aftercare processes.

Inpatient & Observation

• Participates in daily rounds to remove barriers to progression of care.
• Arranges home health, therapy, DME, transportation, and post-discharge follow-up.

Swing Bed Program

• Screens referrals and coordinates admissions per CMS requirements.
• Oversees certifications/recertifications, care plans, and interdisciplinary rounds.
• Tracks Swing Bed program outcomes.

Partnerships (non-supervisory)

• Collaborates with hospital social worker for psychosocial issues, resource needs, and SDoH barriers.
• Coordinates with Geriatric Behavioral Health Director for transitions and aftercare planning.

4. Social Determinants of Health (SDoH)

• Implements SDoH screenings across ED, inpatient, and Swing Bed areas.
• Ensures follow-up and referral to appropriate internal/external resources.
• Maintains updated community resources directory.
• Tracks SDoH trends for CHNA and quality projects.

5. Care Transitions

• Coordinates safe transitions to home, SNFs, home health, hospice, and referral hospitals.
• Ensures discharge components (documentation, referrals, communication) are completed.
• Identifies high-risk patients and implements interventions to reduce readmissions.

6. Loop Closure Responsibilities (Rev Cycle, HIM, Patient Access)

• Ensures communication between UM, Patient Access, Revenue Cycle, and HIM is accurate, complete, and reconciled.
• Follows up on pending documentation, coding needs, status changes, and authorization items.
• Confirms that all parties have acted on communicated tasks (“closes the loop”).
• Verifies provider documentation updates and resolves discrepancies.

7. Community Benefits & Outreach

• Supports CHNA priorities and documents community benefit activities for IRS 990H.
• Builds partnerships with community agencies (DSS, public health, mental health, senior services, schools, churches, nonprofits).
• Participates in or coordinates programs addressing access to care, food insecurity, transportation, housing instability, and chronic disease support.
• Ensures community referrals and follow-up tasks are completed.

8. Regulatory, Quality & Compliance

• Ensures compliance with CMS CAH UR and discharge planning requirements.
• Participates in surveys, audits, and quality improvement initiatives.
• Maintains accurate documentation for UM, Swing Bed, care coordination, and community benefit efforts.
• Provides staff education on UM processes, care transitions, SDoH, and regulatory changes.

REQUIREMENTS

Minimum Level of Education:

• Registered Nurse (RN) required with current licensure in the State of Georgia.
• Bachelor’s degree in Nursing (BSN) preferred but not required.

Work Experience:

• Minimum 2 years of nursing experience in a hospital setting.
• Experience in Utilization Review, Case Management, Care Coordination, Emergency Department, or Swing Bed required.
• Prior supervisory or team lead experience in a healthcare environment preferred.
• Experience working with social services, behavioral health, or community organizations preferred.

Skills and Abilities:

• Strong communication and interpersonal skills.
• Ability to educate and collaborate effectively with physicians and interdisciplinary teams.
• Ability to close communication loops with Patient Access, Revenue Cycle, and HIM.
• Strong organizational and follow-through skills.
• Ability to assess patient needs, including SDoH, and coordinate resources.
• Effective clinical judgment and problem-solving skills.

BENEFITS

JCMC offers a full benefits package including but not limited to health, dental, vision, and company sponsored life insurance.  We also offer 403b and IRA savings and generous time off accruals.

To apply:
We are currently updating our online application system. In the meantime, please email your resume and contact information to jobs@jcmcga.com. Be sure to include the position you are applying for in the subject line of your email. If you prefer a printed application, they are available in our Administration Office, weekdays from 8am-5pm.

Thank you for your interest in joining the JCMC team! We look forward to hearing from you!