Clinical Behavioral Health Utilization Specialist

Ocean Healthcare; Lakeland (NJ); On-site; USD 80,000 - 110,000; Full time

Job summary

Ocean Healthcare in New Jersey seeks an Utilization Review Coordinator to oversee the inpatient behavioral health review process, ensuring medical necessity criteria are met and documentation supports payer requirements. The role partners with physicians, nursing, and social work to secure timely authorizations, reduce denials, and promote quality patient care while maintaining regulatory compliance.

Qualified candidates will have RN or relevant clinician background, a Bachelor’s degree, and 3+

Qualifications

• RN or qualified behavioral health clinician with Bachelor's degree.
• 3+ years inpatient behavioral health experience.
• Experience with utilization review, case management, or managed care is preferred.
• Experience with commercial insurance, Medicare, Medicaid, and authorizations.

Responsibilities

• Coordinate the clinical review process to ensure medical necessity during hospitalization.
• Maximize reimbursement through timely authorization and concurrent review.
• Serve as liaison between hospital and payers to ensure regulatory compliance.
• Collaborate with providers, nursing and social work to meet payer documentation requirements.

Skills

Clinical assessment

Time management

Multitasking

EMR proficiency

Education

Registered Nurse

Bachelor's degree

Tools

EMR systems

Job description

Ocean Healthcare in New Jersey seeks an Utilization Review Coordinator to oversee the inpatient behavioral health review process, ensuring medical necessity criteria are met and documentation supports payer requirements. The role partners with physicians, nursing, and social work to secure timely authorizations, reduce denials, and promote quality patient care while maintaining regulatory compliance.

Qualified candidates will have RN or relevant clinician background, a Bachelor’s degree, and 3+