Utilization Management Coordinator
Utilization Management Coordinator
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1 Vacancy
Job Description
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.
Overview
Rutgers University Behavioral Health Care ( UBHC ) established in 1971 offers a full continuum of evidence based behavioral health and addiction services for children adolescents adults and seniors throughout New Jersey. UBHCs 1060 experienced behavioral health professionals and support staff are dedicated to treatment prevention and education. UBHC one of the largest providers of behavioral health care in the country has a budget of $260 million and has 15 sites throughout New Jersey. Services are readily accessible and include: inpatient outpatient partial hospitalization screening crisis stabilization family/caregiver support community outreach and case management supportive housing supported employment prevention and consultation employee assistance programs and a licensed therapeutic school from preschool through high school. Specialty services include the New Jersey suicide prevention helpline and peer help lines for police veterans active military teachers mothers of special needs children and child protective service workers. In FY2016 UBHC treated 16199 consumers had 24502 admissions and touched the lives of 19441 individual callers through peer support. In addition UBHC is the primary mental health training resource for the New Jersey departments of Human Services Children and Families and Corrections delivering 16000 trainings each year.
Preferred Qualifications
Utilization review experience either working for providers or with third party payers highly preferred. Data entry/computer skills preferred.
Required Experience:
IC
Employment Type
Full-Time
