"Utilization Management Coordinator"

Rutgers The State University is seeking a Utilization Management Coordinator (UM) within Rutgers University Behavioral Healthcare.

Under the direction of the Utilization Review (UR) Supervisor, the Utilization Management (UM) Coordinator conducts utilization reviews to ensure that clinical services meet medical necessity and all applicable standards for regulatory funding and accrediting agencies.

Among the key duties of this position are the following:

• Reviews admissions, continued stays and discharges to determine if they are consistent with established criteria. Refers to the UR Supervisor, those that require additional expertise. If criteria are not met, notifies the UR Supervisor.
• Conducts certification, pre-certification and continuing certification requirements for Medicaid, Medicare and insurance clients.
• Effectively communicates outcomes of precertification and concurrent reviews to appropriate members of the treatment team, leadership and UR Supervisor.
• Communicates routinely with UR Supervisor regarding specific reimbursement issues.
• Serves as resource for treatment team related to medical necessity interventions and documentation.

Minimum Education and Experience:

Registered nurse with a license to practice in the State of New Jersey or a Bachelor's Degree in the Mental Health field.

City: Piscataway

State: NJ