The primary purpose of the Utilization Management Coordinator (UMC) position is to coordinate the patient’s progress through the system. He/she collaborates with physicians and clinical staff to ensure resource utilization is
appropriate to the patient’s clinical and psychosocial needs and that it remains within covered benefits. The UMC conducts reviews using criteria that demonstrate medical necessity to achieve reimbursement, and conducts audits for Quality Indicators. In addition he/she monitors usage of pathways/practice guidelines, performs utilization review functions and meets applicable standards for accrediting agencies. The UMC collaboratively determines level of care needs and interfaces with payers for a smooth transition to the next level of care and services. Supports the mission of University Hospital.
Licensed to practice as a Registered Nurse in the State of New Jersey required. Bachelor's Degree in Nursing or a related health care field required (Master's Degree in Nursing or Health Care related field preferred.) Minimum of four (4) years of related clinical experience required. Experience in case management, utilization review, and/or unit clinical specialty required. Must attain Certification in MCG Guidelines within 18 months of hire as a Utilization Management Coordinator and maintain certification with MCG. CCM or ACMA certification preferred. Basic computer skills required. Ability to work effectively and collaboratively with interdisciplinary teams. Demonstrates resourcefulness, effective written and oral communication, negotiating and analytical skills. Additional related experience, education and/or training may be substituted for the Bachelor’s Degree. Must be available to rotate on weekends as part of a team.