Utilization Review Coordinator jobs in Somerset, NJ

Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)

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Utilization Review Specialist
  • Hunterdon Health
  • Flemington, NJ PER_DIEM
  • osition Summary

    The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services and monitors the appropriateness of hospital admissions and extended hospital stays. The evaluation of the appropriateness and medical necessity of health care services, procedures, and facilities is conducted through the application of evidence-based criteria or guidelines, and through authorization/prior authorization under the provisions of an applicable health insurance plan.

    Primary Position Responsibilities

    1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the Physician Advisor, to provide clinical information to payors as requested and ensures correct status of all patients to insure maximum reimbursement.

    2. Works with medical and clinical staff to improve overall quality and completeness of clinical documentation.

    3. Communicates and educates medical, clinical and coding staff of trends and opportunities for improvement.

    4. Tracks and trends all queries presented to medical and clinical staff.

     

    Qualifications

    Minimum Education:

    Required:

    All hires after July 2012 are required to have a Bachelor's Degree in nursing OR if Associates Degree or Diploma, RN must provide proof of enrollment in a BSN program prior to hire, be continuously enrolled and complete within 5 years of hire date or internal RN promotion date.


    Minimum Years of Experience (Amount, Type and Variation):

    Required:

    Three years of medical/surgical hospital based direct patient care experience.

    Preferred:

    Five years of medical/surgical hospital based direct patient care experience.


    License, Registry or Certification:

    Required:

    Current NJ RN Licensure. 


    Knowledge, Skills and/or Abilities:

    Required:

    Excellent verbal, written, organizational and interpersonal skills. Demonstrates experience in patient care evaluation methodologies, analysis and reporting of patient clinical data to various payee sources using Miliman Care Guideline criteria sets.

     

  • 2 Months Ago

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RCO-Advanced Claims Review Specialist
  • PharmScript, LLC
  • Somerset, NJ FULL_TIME
  • Overview PharmScript is one of the nation’s leading pharmacies, partnering with long-term and post- acute care facilities to supply medications to thousands of residents and patients. When you join th...
  • 13 Days Ago

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2024 Summer Intern - Best News and Review
  • AM Best Company
  • Oldwick, NJ INTERN
  • Overview Best Insurance News & Analysis and Best’s Review – Research articles, maintain databases, assist with producing and proofreading issues and writing occasional news articles. There will also b...
  • 15 Days Ago

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Nurse/Registered Nurse / Patient Safety (Review)
  • Tellus Solutions
  • Somerville, NJ CONTRACTOR,FULL_TIME
  • Job Description: Client is looking for a Nurse II in the area of Review or case management Qualifications: Associates Degree or, BSN or BS in Life Science preferred Acute Critical Care Organ donation ...
  • 1 Month Ago

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Nurse(Acute Critical Care,Organ Transplant,Review or Case management)
  • Tellus Solutions
  • Somerville, NJ CONTRACTOR,FULL_TIME
  • Job Description:Responsibilities: Responsible for maintaining compliance with FDA, AATB, international and state regulations during the second level quality review of all tissue donor files for tissue...
  • 1 Month Ago

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Coordinator
  • IQVIA
  • Bridgewater, NJ FULL_TIME
  • Job Overview This role is dedicated to a large pharma customer who executes over 10,000 Speaker Bureau meetings annually with IQVIA. In this role we are looking for a detail oriented, strong communica...
  • 11 Days Ago

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0 Utilization Review Coordinator jobs found in Somerset, NJ area

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Administrative Research Associate
  • Rutgers University
  • New Brunswick, NJ
  • Position Details Position Information Recruitment/Posting Title Administrative Research Associate Job Category Staff & E...
  • 3/18/2024 12:00:00 AM

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REGISTERED HOSPICE NURSE (RN)-
  • Swan Hospice
  • Middlesex, NJ
  • Swan Hospice - Swan Hospice is actively seeking Registered Nurses (RN) to join our team in Central New Jersey. We provid...
  • 3/18/2024 12:00:00 AM

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Police Administrative Assistant
  • Township of Edison
  • Edison, NJ
  • Police Administrative Assistant Police Administration Senior - Principal 2019 Salary $47,150 Interested candidates must ...
  • 3/17/2024 12:00:00 AM

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Clerk Typist
  • Township of Edison
  • Edison, NJ
  • Clerk Typist Senior - Principal Annual Salary $28,700.00 35 hour week Interested candidates must submit their resume and...
  • 3/17/2024 12:00:00 AM

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Utilities Coordinator / Apartment Services Specialist
  • Furnished Quarters
  • New York, NY
  • Company Overview Furnished Quarters sits at the exciting intersection of travel, hospitality, real estate, lifestyle, an...
  • 3/15/2024 12:00:00 AM

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Clerk 1
  • Middlesex County
  • New Brunswick, NJ
  • Overview: Under close supervision, performs routine, repetitive clerical work involving the processing of documents in a...
  • 3/15/2024 12:00:00 AM

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Apprentice Project Coordinator
  • Careerbuilder
  • New Brunswick, NJ
  • About Us Groundbreaker. Game changer. Pioneer. TRC has long set the bar for clients who require more than just engineeri...
  • 3/15/2024 12:00:00 AM

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Formulation Management Assistant
  • Allen Flavors Inc
  • South Plainfield, NJ
  • Job Description Job Description FORMULATION MANAGEMENT ASSISTANT Company Overview: Allen Flavors, Inc. is a flavor formu...
  • 3/14/2024 12:00:00 AM

Somerset is an unincorporated community and census-designated place (CDP) located within Franklin Township, in Somerset County, New Jersey, United States. As of the 2010 United States Census, the CDP's population was 22,083. Somerset housed one of the first Marconi Wireless Stations in the United States. According to the United States Census Bureau, the CDP had a total area of 6.444 square miles (16.692 km2), including 6.327 square miles (16.388 km2) of land and 0.117 square miles (0.304 km2) of water (1.82%)....
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Coordinator jobs
$90,842 to $112,522
Somerset, New Jersey area prices
were up 1.5% from a year ago

Utilization Review Coordinator in Fort Lauderdale, FL
Some review coordinator positions require that professionals have training and experience within a more specific field.
January 10, 2020
Utilization Review Coordinator in Asheville, NC
Schick Shadel Hospital is seeking a part-time (20 hours per week) Utilization Review Coordinator (UR Coordinator) to help oversee and perform the process of utilization review to ensure appropriate reimbursement by third party payers.
January 04, 2020
Utilization Review Coordinator in Jacksonville, FL
Excellent benefits, pay, small on-site employee gym, wonderful co-workers and managersFull Review.
January 04, 2020