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Utilization Management Coordinator

Hackensack University Medical Center

This is a Contract position in Neptune, NJ posted March 22, 2020.

OverviewHow have you impacted someone’s life today? At Hackensack Meridian Health our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career, all within New Jersey’s premier healthcare system.Responsibilities* Review Activities: Admission review, admission denial, continued stay review, continued stay denial, termination of benefits, communication of information to insurance company, billing certification, concurrent managed care, Denial Appeals, retrospective medical record utilization review.* Obtains and evaluates medical records for in patient admissions to determine if required documentation is present.* Obtains appropriate records as required by payer agencies and initiates physician advisors as necessary for unwarranted admissions.* Conducts on going review and discusses care changes with attending physicians and others.* Performs chart reviews for appropriateness of admission and continued hospital stay applying appropriate clinical criteria. Performs admission review within 24 hours or the first business day.* Refers cases not meeting criteria to the physician advisor for determination and action.Qualifications* Current and valid New Jersey Nursing license is required* Minimum of five years experience in the acute care setting required* Previous case management/utilization review experience preferred* BSN preferred* Certified Case Manager preferred* Knowledge of federal and state regulations, third party payers/managed care principles* Knowledge of InterQual/Milliman criteria and other guidelines for medical necessity, appropriate level of care, and concurrent patient management* Knowledge of health care delivery system, utilization review, and case review procedures* Computer skills to include Microsoft Word, Excel, and basic data entry* Strong organizational and problem solving skills* Excellent oral, written, and interpersonal skills