Utilization Management Coordinator

Utilization Management Coordinator

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

FLSA - Exempt

Grade - 25S

Salary Details

Minimum Salary - 71162.000

Mid Range Salary - 85428.000

Maximum Salary - 101456.000

Offer Information - The final salary offer may be determined by several factors, including, but not limited to, the candidate's qualifications, experience, and expertise, and availability of department or grant funds to support the position. We also take into consideration market benchmarks, if and when appropriate, and internal equity to ensure fair compensation relative to the university's broader compensation structure. We are committed to offering competitive and flexible compensation packages to attract and retain top talent.

Benefits - Rutgers provides a comprehensive benefits package to eligible employees. The specific benefits vary based on the position and may include: 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

Position Status - Full Time

Working Hours - 28 hours

Standard Hours - 37.50

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 View email address on click.appcast.io Application System.

Union Description - HPAE 5094

Payroll Designation - PeopleSoft

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 - Registered Nurse. 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 - PHYSICALDEMANDS: 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. WORKENVIRONMENT: 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

Posting Details

Posting Number - 26ST0808

Posting Open Date

Special Instructions to Applicants

Regional Campus - Rutgers Biomedical and Health Sciences (RBHS)

Home Location Campus - Piscataway (RBHS)

City - Piscataway

State - NJ

Location Details

Pre-employment Screenings All offers of employment are contingent upon successful completion of all pre-employment screenings. Immunization Requirements Under Policy 100.3.1 Immunization Policy for Covered Individuals, if employment will commence during Flu Season, Rutgers University may require certain prospective employees to provide proof that they are vaccinated against Seasonal Influenza for the current Flu Season, unless the University has granted the individual a medical or religious exemption. Additional infection control and safety policies may apply. Prospective employees should speak with their hiring manager to determine which policies apply to the role or position for which they are applying. Failure to provide proof of vaccination for any required vaccines or obtain a medical or religious exemption from the University will result in rescission of a candidate's offer of employment or disciplinary action up to and including termination.

Equal Employment Opportunity Statement It is university policy to provide equal employment opportunity to all its employees and applicants for employment regardless of their 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, affectional or sexual orientation, atypical cellular or blood trait, genetic information (including the 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: