Utilization Review Coordinator

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

The Utilization Review (UR) Coordinator is responsible for coordinating the clinical review process to ensure appropriate utilization of inpatient psychiatric services while maximizing reimbursement through timely authorization, concurrent review, and denial prevention. Working collaboratively with providers, nursing, and social work, the UR Coordinator ensures patients meet medical necessity criteria throughout their hospitalization, and documentation supports payer requirements.

This position serves as a key liaison between the hospital and insurance payers to promote quality patient care, regulatory compliance, and financial stewardship.

Education

• Registered Nurse or other qualified behavioral health clinician strongly preferred.
• Bachelor's degree required.

Experience

• 3+ years of inpatient behavioral health experience.
• Previous utilization review, case management, discharge planning, or managed care experience are strongly preferred.
• Experience with commercial insurance, Medicare, Medicaid, and managed care authorization processes.

Knowledge, Skills, and Abilities

• Strong understanding of behavioral health medical necessity criteria (MCG preferred).
• Knowledge of psychiatric documentation standards and payer expectations.
• Experience conducting concurrent reviews and communicating effectively with insurance reviewers.
• Excellent clinical assessment and critical thinking skills.
• Strong verbal and written communication abilities.
• Exceptional organizational and time management skills.
• Ability to manage multiple payer deadlines simultaneously.
• Proficiency with electronic medical records.
• Strong collaboration and team building skills with interdisciplinary teams.