Utilization Management Director jobs in New Brunswick, NJ

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The Utilization Management Coordinator coordinates and monitors daily activities of the utilization management functions of the Care Coordination Department, ensuring the appropriate allocation of hospital resources while maintaining quality of patient care. This position also holds the responsibility for ensuring regulatory compliance requirements and coordinating the medical management aspects of clinical review requests from external entities. The Utilization Management Coordinator serves as a functional expert and liaison to Care Coordinator Staff and other departments within the hospital system. The UM Coordinator assists to develop consistent processes and enhance workflow of the concurrent review process with third party payers. The UM Coordinator oversees and facilitates medical necessity appeals as the result of concurrent denials. The UM Coordinator functions as the PRO Liaison facilitating the review process for Hospital Issued Notices of Non-Coverage (HINN's) and discharge reviews as they relate to Care Coordinator activities and directing PRO correspondence and cost outliers to the appropriate internal department. Provides Care Coordination Support as needed.