Inpatient Coordinator

Inpatient Coordinator

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 200+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources. HCP's vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP's mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team?

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.

Qualification Requirements: 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.

Training/Education:

• 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.

Experience:

• Minimum of 35 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.

Base Compensation: $45,000 - $55,000 (21.63 - $26.44 per hour) Bonus Incentive: Eligibility based off organizational performance Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.) Equal Employment Opportunity Statement: HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Job Disclaimer: The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.