Utilization Management Coordinator UCHC

with established quality management procedures. Performs clinical/medical reviews for all changes in levels of care based on medical necessity criteria, continued length of stay reviews, and discharge follow up for all levels of care. Identifies pertinent clinical information necessary to certify admission and continued lengths of stay and or coordinate transfer back to NJDOC infirmary services and to evaluate quality of care in accordance with pre-established criteria. Consults with Statewide Medical Director/designee on all complex cases or continued stay issues. Assesses each patient being reviewed for high-risk status (multiple medical problems/multiple hospital admissions) and arranges as necessary clinical follow up on all identified high-risk patients. Performs data entry of assigned cases in a timely manner. Maintains close interaction with internal and external customers in a professional manner. Communicates in a professional and courteous manner. Works closely with medical personnel, billing, patient accounting, and utilization management departments of hospitals and other healthcare entities to maximize health care delivery within the prison system and minimize expenses for ancillary medical care and hospitalization while meeting the medically necessary medical treatment of the inmates. Develops and manages the existing UCHC provider network. Develops and maintains relationships with healthcare providers required to supplement the health care network available directly through UCHC within NJDOC facilities to assure inmates have access to medically necessary medical treatment. Minimizes the delivery of any healthcare by another healthcare entity that could be provided within the existing health care system within NJDOC . Obtains clinical information to substantiate medical necessity by reviewing patient charts, attending department rounds and treatment planning, and by talking to physicians and other healthcare providers. City: Trenton State: NJ Special Conditions: Must be approved by the Department of Corrections ( DOC ) and adhere to all DOC requirements. Posting Number: 26ST1850