Utilization Management Coordinator

Posting Summary

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

The primary purpose of the Utilization Management Coordinator is to coordinator conduct utilization reviews to ensure that clinical services meet medical necessity and all applicable standardsfor 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.

Position Status Full Time Hours Per Week Daily Work Shift Work Arrangement Consistent with the current application of Rutgers Policy 60.

3.22 or the applicable provisions of relevant collective negotiations agreements, this position may be eligible for a hybrid work arrangement.

Flexible work arrangements are not permanent, are subject to change or discontinuation, and contingent on the employee receiving approval in the FlexWork@RU Application System.

FLSA Exempt Grade 25S Position Salary Annual Minimum Salary 70041.00 Annual Mid Range Salary 84083.00 Annual Maximum Salary 99858.

00 Standard Hours 37.50 Union Description HPAE 5094 Payroll Designation PeopleSoft Benefits Rutgers offers a comprehensive benefit program to eligible employees. For details, please go to .

Seniority Unit Terms of Appointment Staff - 12 month Position Pension Eligibility ABP Qualifications 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

Certifications / Licenses

Applicants possessing a degree in Social Work must have an active New Jersey certification / licensure as required by the State Board of Social Work.

Required Knowledge, Skills, and Abilities Preferred Qualifications

• Utilization review experience either working for providers or with third party payers highly preferred.
• Data entry / computer skills preferred.

Equipment Utilized 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. Special Conditions