Utilization Management Coordinator UCHC

Rutgers University; Trenton (NJ); Hybrid; USD 71,000 - 101,000; Full time

Benefits offered by this job

Medical, prescription drug, and dental

Paid vacation and holidays

Retirement benefits

Educational benefits

Life insurance

Employee discount programs

Job summary

Rutgers University Correctional Health Care (UCHC) seeks a Utilization Management Coordinator to perform utilization reviews for hospital and auxiliary services, negotiate pricing, and coordinate patient care within NJDOC facilities. This role is based in the central administration in Trenton, NJ and requires onsite work.

The ideal candidate holds a BSN or related clinical degree with at least two years of experience, including one year in a correctional setting, CPR certification, and a valid

Qualifications

• Bachelor's degree in nursing or related clinical field; BSN preferred.
• Minimum of two years related experience.
• Minimum of one year of experience in a correctional setting preferred; CPR certification.
• Valid driver’s license and access to own vehicle.
• Computer literacy required.

Responsibilities

• Performs utilization reviews for medical services provided by hospitals and other facilities.
• Negotiates re-pricing charges for hospital and other auxiliary medical services.
• Performs data entry of assigned cases in a timely manner.
• Develops and maintains relationships with healthcare providers to supplement the health care network.
• Assesses high-risk patients and coordinates necessary clinical follow-up.

Skills

CPR Certification

Computer literacy

Valid driver’s license

Education

Bachelor of Nursing (BSN) or related clinical field

Job description

Department

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

Grade 25S

Salary Details

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

Seniority Unit

Terms of Appointment

Staff - 12 month

Position Pension Eligibility

ABP

Qualifications

Minimum Education and Experience

Certifications/Licenses

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
• Valid driver’s license is required. Possesses own vehicle or alternative means of transportation from one site to another.
• Computer literacy.

Preferred Qualifications

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

Physical Demands and Work Environment

Special Conditions

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

Posting Number

26ST1850

Posting Open Date

Special Instructions to Applicants

Regional Campus

Rutgers Biomedical and Health Sciences (RBHS)

Home Location Campus

Off Campus

City

State

NJ

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

Supplemental Questions

• * Do you have a Bachelor of Nursing (BSN) or bachelor’s degree in related clinical field (LCSW, LFC, Psychology)? Please specific Bachelors degree.
  • Open Ended Question
• * Do you have a minimum of 2 years related experience?
  • Yes
  • No
• * Do you have a minimum of one (1) year of experience in a correctional setting?
  • Yes
  • No
• * Are you currently CPR Certified?
  • yes
  • no
• * Do you have a valid Driver’s License and possesses own vehicle or alternative means of transportation from one site to another?
  • Yes
  • No
• * Do you have a minimum of one year experience as a Utilization Review Nurse?
  • Yes
  • No

Required Documents

• Resume/CV
• Certifications/Licenses
• CPR Certification

Optional Documents

• Cover Letter/Letter of Application

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: Non-Discrimination-Statement .

In compliance with the Americans with Disabilities Act (ADA) and the New Jersey Law Against Discrimination (NJLAD), if you have a disability and would like to request an accommodation with regard to your access to and/or your participation in the application and selection processes (for example, the online application process or interviews), please call 848-932-3973 or e-mail us .

Rutgers University is an equal access/equal opportunity institution. If you have trouble accessing this page because of a disability, please contact us at 732.745.7378 or via email at [e-mail] .

Rutgers University participates in the E-Verify program as required by law. Learn more about the E-Verify program .

For technical assistance with the applicant tracking system (login, filling out your application, resetting your password, etc.) please contact the ROCS Help Desk at 848-932-4444 or [e-mail] .