Utilization Management Coordinator
: Job Details :

Position DetailsPosition InformationRecruitment/Posting Title Utilization Management Coordinator Job Category Staff & Executive - Other Department UBHC-P-VICE PRES & CEO-PISC OverviewRutgers 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 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 16,199 consumers, had 24,502 admissions, and touched the lives of 19,441 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 16,000 trainings each year.Posting SummaryRutgers, 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 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:* 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.Position Status Full Time Hours Per Week Daily Work Shift Work ArrangementConsistent 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 BenefitsRutgers offers a comprehensive benefit program to eligible employees. For details, please go to Unit Terms of Appointment Staff - 12 month Position Pension Eligibility ABPQualificationsMinimum 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 EnvironmentPHYSICAL 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 ConditionsPosting DetailsPosting Number 24ST2773 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 DetailsPre-employment ScreeningsAll offers of employment are contingent upon successful completion of all pre-employment screenings.Immunization RequirementsUnder 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.Affirmative Action/Equal Employment Opportunity StatementIt 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 value diversity of background and opinion, and prohibit discrimination or harassment on the basis of any legally protected class in the areas of hiring, recruitment, promotion, transfer, demotion, training, compensation, pay, fringe benefits, layoff, termination or any other terms and conditions of employment. For additional information please see the Non-Discrimination Statement at the following web address: QuestionsRequired fields are indicated with an asterisk (*).* * Are you a registered nurse with a license to practice in the State of New Jersey or do you a Bachelor's Degree in the Mental Health field?* Yes* No* * Do you have at least three (3) years of mental health experience* Yes* No* * Do you have utilization review experience either working for providers or with third party payers?* Yes* No* * Do you have Data entry/computer skills?* Yes* NoApplicant DocumentsRequired Documents* Resume/CVOptional Documents* Cover Letter/Letter of Application