Utilization Management Coordinator

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. UBHC’s 1,060 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 15 sites throughout New Jersey. Services 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 16,199 consumers, had 24,502 admissions, and touched the lives of 19,441 individual callers through peer support. UBHC also delivers 16,000 training sessions each year for the New Jersey departments of Human Services, Children and Families, and Corrections. Responsibilities Review admissions, continued stays, and discharges to determine if they are consistent with established criteria. Refer cases requiring additional expertise to the UR Supervisor; notify the supervisor if criteria are not met. Conduct certification, pre‑certification, and continuing certification requirements for Medicaid, Medicare, and insurance clients. Effectively communicate outcomes of pre‑certification and concurrent reviews to the treatment team, leadership, and UR Supervisor. Communicate routinely with the UR Supervisor regarding specific reimbursement issues. Serve as a resource for the treatment team related to medical necessity interventions and documentation. Assist treatment team members in discharge planning and obtaining authorization for the next level of care as needed. Participate in data collection related to patient status and needs. Identify and report quality‑of‑care issues/concerns to the supervisor. Ensure insurance information is current, including background investigation if no insurance card is available. Perform data entry of assigned cases in a timely manner. 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. At least three (3) years of mental‑health experience. Certifications/Licenses Registered Nurse. Applicants with a degree in Social Work must have an active New Jersey certification/licensure as required by the State Board of Social Work. Preferred Qualifications Utilization review experience with providers or third‑party payers highly preferred. Data entry/computer skills preferred. Benefits Medical, prescription drug, and dental coverage Paid vacation, holidays, and various leave programs Competitive retirement benefits, including defined contribution plans and voluntary tax‑deferred savings options Employee and dependent educational benefits (when applicable) Life insurance coverage Employee discount programs Optional benefits such as community outreach and workforce development (subject to availability) Physical Demands and Work Environment PHYSICAL DEMANDS Extensive reading required. Lifting up to 10 pounds. Extended periods of sitting, walking, standing. Some driving to various locations throughout New Jersey for meetings. WORK ENVIRONMENT Moderate noise (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. Equal Employment Opportunity Statement It is university policy to provide equal employment opportunity to all its employees and applicants for employment regardless of race, creed, color, national origin, age, ancestry, nationality, marital or domestic partnership or civil union status, sex, pregnancy, gender identity or expression, disability status, liability for military service, protected veteran status, affectionate or sexual orientation, atypical cellular or blood trait, genetic information (including refusal to submit to genetic testing), or any other category protected by law. As an institution, we encourage all qualified applicants to apply. For additional information please see the Non‑Discrimination Statement at the following web address: #J-18808-Ljbffr