Care Facilitator- St. Lawrence Region

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Quick Summary

Key Responsibilities

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

Requirements Summary

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

Technical Tools

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Responsibilities

~1 min read

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Conducts clinical reviews using Interqual criteria to determine appropriate patient level of care, document medical necessity, and support reimbursement.
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Monitors resource utilization through continued stay reviews, manages length of stay, and coordinates with Physician Advisors for complex cases.
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Serves as a liaison between hospital and payors, ensuring accurate communication of clinical information, supporting appeals, and optimizing benefit use.
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Collaborates with care teams to resolve barriers to care, participates in daily huddles, and uses data to identify opportunities for process improvement.

Requirements

~1 min read

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

Case Management or Utilization Management experience
Bachelor’s Degree

Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67–100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver’s license.

BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - NYS Office of ProfessionsNew York State Education Department (NYSED)New York State Education Department (NYSED)

$70,000.00 - $95,000.00

Massena

13662

Location & Eligibility

Where is the job

Not specified

Location terms not specified

Who can apply

Same as job location

About this job

Pay per year: $70,000–$95,000 a year; 21% above the $68,006 median for Other jobs on Jobera (131,969 salaries).
Posted: Today
Employer: has 1,379 open jobs on Jobera.