Utilization Review Manager - Healthcare Compliance Lead

Christian Health; Wyckoff (NJ); On-site; USD 95,000 - 110,000; Full time

Benefits offered by this job

Discounted health insurance

Dental program

Paid vacation

Personal days

Holidays and Sick leave NJ

401k plan

Group Life Insurance

Tuition Reimbursement

Employee Assistance Program

Free onsite parking

Free meals for all employees

Job summary

Christian Health in New Jersey is seeking a full-time Utilization Review Manager to lead our UR department. The role ensures effective use of healthcare resources and compliance with regulatory and payer requirements.

You will review medical records, verify documentation for inpatient and partial hospitalization, collaborate with social services, and support discharge planning. A 3-5 year hospital UR background and leadership skills are essential.

Qualifications

• 3-5 years clinical hospital experience (Behavioral Health experience helpful).
• UR/management/quality experience preferred.
• Interpersonal skills to interpret information for patient needs and age-related criteria.
• Knowledge of laws/regulations pertaining to Behavioral Health, Medicare, Medicaid, and payers.
• Must possess leadership and supervisory ability.
• Computer literacy with MS Windows, Outlook, Word, Excel and Internet navigation.

Responsibilities

• Oversees and directs all UR department operations.
• Reviews medical records for compliance with clinical and regulatory requirements.
• Verifies documentation for inpatient and partial hospitalization meets medical necessity.
• Collaborates with social services and participates in discharge planning.
• Provides timely clinical reviews to support managed care.
• Evaluates denials and supports appeals when appropriate.
• Provides VP of Revenue Cycle with regular feedback and reports.

Skills

Clinical hospital experience

Utilization review/management

Leadership

Regulatory knowledge

Interpersonal skills

Computer literacy (MS Office)

Education

Accredited nursing or medical school graduate

Tools

MS Windows

Outlook

Word

Excel

Internet/Intranet navigation

Job description

Christian Health in New Jersey is seeking a full-time Utilization Review Manager to lead our UR department. The role ensures effective use of healthcare resources and compliance with regulatory and payer requirements.

You will review medical records, verify documentation for inpatient and partial hospitalization, collaborate with social services, and support discharge planning. A 3-5 year hospital UR background and leadership skills are essential.