Utilization Management Coordinator

Position Summary:

Rutgers, The State University of New Jersey is seeking a Utilization Management Coordinator for the Utilization Management within Rutgers University Behavioral Health Care.

The primary purpose of the Utilization Management Coordinator position is to conduct 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.
• Assists treatment team members in discharge planning in obtaining authorization for the next level of care as needed.
• Participates in data collection related to patient status and needs.
• Identifies and reports quality-of-care issues/concerns to supervisor.
• Ensures that insurance information is current with background investigation if no insurance card available.
• Performs data entry of assigned cases in a timely manner

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.
• Must have at least three (3) years of mental health experience.

City: Piscataway

State: NJ

Physical Demands and Work Environment:

PHYSICAL DEMANDS: Extensive reading required. Lifting of up to 10 pounds. Extended periods of sitting. Walking throughout the day. Standing for extended periods of time. Some driving to various locations throughout New Jersey for meetings.

WORK ENVIRONMENT: Moderate noise (examples: business office with computers and printers, light traffic). Subject to unpredictable situations, patient crises, both medical and psychiatric. Occasionally exposed to patients exhibiting assaultive behaviors.