Utilization Management Coordinator UCHC

Rutgers University; New Brunswick (NJ); On-site; USD 71,000 - 101,000; Full time

Benefits offered by this job

Health benefits

Paid leave

Retirement plan

Education benefits

Life insurance

Employee discounts

Job summary

Rutgers University Correctional Health Care (UCHC) seeks a Utilization Management Coordinator in the central administration offices in Trenton, NJ. The role conducts utilization reviews for medical services and negotiates pricing with hospitals and other providers.

Responsibilities include detailed chart review, coordinating care transfers, and maintaining relationships with providers and departments to control costs while ensuring medically necessary care for inmates.

Qualifications

• Bachelor of Nursing or related clinical degree; substitution of experience allowed.
• Minimum of two years of related experience.
• CPR Certification; valid driver’s license; computer literacy.

Responsibilities

• Performs utilization reviews and quality improvement reviews per established procedures.
• Negotiates re-pricing charges for hospital and other medical services.
• Maintains professional interactions with internal and external customers.
• Develops and manages the UCHC provider network.

Skills

Healthcare admin

Utilization review

Communication skills

CPR Certification

Computer literacy

Driver's license

Education

Bachelor’s degree in Nursing or related clinical field

Job description

Position Details

Recruitment/Posting Title: Utilization Management Coordinator UCHC

Job Category: Staff & Executive - Healthcare - Administrative Services

Department: UCHC Administration

Overview

University Correctional Health Care (UCHC), operating within Rutgers, The State University of New Jersey, is dedicated to excellence in providing physical, mental health, dental and sex offender treatment services to those involved in the criminal justice systems in New Jersey. UCHC operates with a total budget of $150 million and approximately 1,000 staff.

We are committed to being a leader in the delivery of effective, compassionate and accessible care informed by research within correctional environments.

We Care. We Teach. We Heal. We Improve.

Rutgers, The State University of New Jersey, is a leading national research university and the state of New Jersey's preeminent, comprehensive public institution of higher education. Established in 1766 and celebrating a milestone 250th anniversary in 2016, the university is the eighth oldest higher education institution in the United States. More than 67,000 students and 22,000 faculty and staff learn, work, and serve the public at Rutgers locations across New Jersey and around the world.

Posting Summary

Rutgers University Correctional Health Care (UCHC) is seeking a Utilization Management Coordinator located in the central administration offices located in Trenton, NJ. The Utilization Management Coordinator performs utilization reviews for medical services provided by hospitals and other auxiliary medical services. Negotiates re-pricing charges for hospital and other auxiliary medical services.

Duties include:

• Performs utilization/quality improvement reviews in accordance with established quality management procedures.
  • Performs clinical/medical reviews for all changes in levels of care based on medical necessity criteria, continued length of stay reviews, and discharge follow up for all levels of care.
  • Identifies pertinent clinical information necessary to certify admission and continued lengths of stay and or coordinate transfer back to NJDOC infirmary services and to evaluate quality of care in accordance with pre-established criteria.
  • Consults with Statewide Medical Director/designee on all complex cases or continued stay issues.
  • Assesses each patient being reviewed for high-risk status (multiple medical problems/multiple hospital admissions) and arranges as necessary clinical follow up on all identified high-risk patients.
  • Performs data entry of assigned cases in a timely manner.
• Maintains close interaction with internal and external customers in a professional manner.
  • Communicates in a professional and courteous manner.
  • Works closely with medical personnel, billing, patient accounting, and utilization management departments of hospitals and other healthcare entities to maximize health care delivery within the prison system and minimize expenses for ancillary medical care and hospitalization while meeting the medically necessary medical treatment of the inmates.
• Develops and manages the existing UCHC provider network.
  • Develops and maintains relationships with healthcare providers required to supplement the health care network available directly through UCHC within NJDOC facilities to assure inmates have access to medically necessary medical treatment.
  • Minimizes the delivery of any healthcare by another healthcare entity that could be provided within the existing health care system within NJDOC.
  • Obtains clinical information to substantiate medical necessity by reviewing patient charts, attending department rounds and treatment planning, and by talking to physicians and other healthcare providers.

FLSA

Exempt

Grade

25S

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

• 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

40

Standard Hours

40.00

Daily Work Shift

Day

Work Arrangement

This position requires a full onsite work arrangement.

Union Description

HPAE 5094

Payroll Designation

PeopleSoft

Terms of Appointment

Staff - 12 month

Position Pension Eligibility

ABP

Qualifications

Required Knowledge, Skills, and Abilities

• Bachelor of Nursing (BSN) or bachelor's degree in related clinical field (LCSW, LFC, Psychology). Additional related experience may be substituted for the degree on a year-for-year basis.
• A minimum of two (2) years of related experience
• Minimum of one (1) year of experience in a correctional setting preferred. CPR Certification
• Computer literacy.
• Valid driver's license is required. Possesses own vehicle or alternative means of transportation from one site to another.

Preferred Qualifications

• Minimum of one (1) year of experience as a Utilization Review Nurse is highly desirable.

Special Conditions

Must be approved by the Department of Corrections (DOC) and adhere to all DOC requirements.

Posting Details

Posting Number

26ST1850

Regional Campus

Rutgers Biomedical and Health Sciences (RBHS)

Home Location Campus

Off Campus

City

Trenton

State

NJ

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: http://uhr.rutgers.edu/non-discrimination-statement