Utilization Review Coordinator jobs in Clifton, NJ

Job Overview:
We are seeking a highly skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will be responsible for reviewing medical records and assessing the appropriateness and necessity of healthcare services provided to patients. Your role will be crucial in ensuring quality patient care and optimizing resource utilization.

Duties:
- Conduct comprehensive reviews of medical records to evaluate the medical necessity and efficiency of healthcare services
- Collaborate with healthcare providers to obtain additional information or clarification regarding patient care
- Analyze clinical documentation to ensure accurate representation of patient conditions and treatments
- Utilize industry standards, such as HEDIS, to assess the quality of care provided
- Apply knowledge of medical coding systems (e.g., DRG) to accurately assign appropriate codes for reimbursement purposes
- Collaborate with case managers and other healthcare professionals to develop effective care plans
- Participate in utilization management activities to monitor and control healthcare costs
- Maintain accurate and detailed documentation of all review activities

Experience:
- Valid nursing license
- Previous experience in utilization review, discharge planning, or a related field preferred
- Strong knowledge of medical documentation standards and guidelines
- Familiarity with utilization management principles and practices
- Proficiency in using electronic health record (EHR) systems, such as Athenahealth
- Experience working in acute care settings is highly desirable
- Knowledge of hospice care is a plus
- Excellent analytical and critical thinking skills

Job Type: Full-time

Pay: $1.00 - $1.50 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 12 hour shift
• 8 hour shift

Ability to Relocate:

• Boonton, NJ 07005: Relocate before starting work (Required)

Work Location: In person