JFK Johnson Rehabilitation Institute · 22 hours ago
UM COORDINATOR - UTILIZATION REVIEW - P/T WITH BENEFITS DAYS
Belle Mead, NJ
Part-time
Onsite
Mid, Senior Level
5+ years expHackensack Meridian Health is a recognized healthcare network dedicated to transforming healthcare and serving as a leader of positive change. The UM Coordinator will utilize clinical knowledge to review and coordinate care for a designated patient caseload, collaborating with treatment teams to ensure appropriate utilization of resources and benefits.
Hospital & Health Care
Responsibilities
Perform admission reviews to assure that the level of care criteria are met
In collaboration with the Access Center and Unit staff, assure that certification is completed at the earliest possible entry into the system, and recertification occurs timely
Perform concurrent reviews with third party payers and communicate potential or identified concerns to the treatment team, Director of Utilization Management, and the Medical Director
Review charts at identified review points and attend treatment planning conferences or team meetings, collecting data pertaining to clinical status and justifying the medical necessity for continued treatment in inpatient level of care. Referral of cases with questionable medical necessity to Physician Advisor for determination
Review clinical and diagnostic interventions for appropriateness and timeliness to achieve optimal clinical and financial patient outcomes
Participate in interdisciplinary team meetings as it relates to the following: insuring appropriate length of stay, reviewing treatment interventions, developing and implementing discharge plans
Collaborate with Patient Financial Services, Access Center and the clinical treatment team to insure optimal reimbursement for services provided
Review concurrent denials from third party payers with the interdisciplinary treatment team and orchestrate the appeal process where indicated
Anticipate patients' readiness for discharge and collaborate with primary therapists and discharge planners regarding transition to alternative levels of care
Perform concurrent utilization review applying identified criteria at prescribed review points, and retrospective focus reviews in concordance with department objectives
Perform all administrative tasks related to caseload such as Meditech documentation, continuity of care referral paperwork, team, committee, or special project reports, etc
Maintain competencies and professionalism by participating in educational opportunities with focus on case management, psychiatric and/or additional treatment issues/trends
Participate in the development and refinement of the Case Management Program
Participate in department and hospital committees
Other duties and/or projects as assigned
Adheres to HMH Organizational competencies and standards of behavior
Qualification
Required
RN, BSN, or Bachelors degree in a clinical field with a health care focus
Minimum five years of clinical experience in a behavioral health care setting
Excellent written and verbal communication skills
Proficient computer skills that may include but are not limited to Microsoft Office and/or Google Suite platforms
Preferred
Master's Degree
NJ State Professional Registered Nurse License or NJ Licensed Social Worker
Benefits
Workplace excellence
Collaborative work environment
Work-life balance
Compassionate nursing culture
Mentoring programs
Substantial tuition reimbursement
Company
JFK Johnson Rehabilitation Institute
Offering New Jersey’s most comprehensive rehabilitation services, JFK Johnson Rehabilitation Institute is a 94-bed facility located in Edison, NJ, serving residents of the tristate area for more than 40 years.
10001+ employees
Funding
Current Stage
Late StageCompany data provided by crunchbase