Utilization Review Technician jobs in Somerset, NJ

Utilization Review Technician 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 Technician 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 Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 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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Emergency Nurse/Emergency department(Actue Critical Care,Review,Case Management,Transplant unit)
  • Tellus Solutions
  • Branchburg, 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...
  • 4 Days Ago

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0 Utilization Review Technician jobs found in Somerset, NJ area

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SEO Tech Specialist (Remote)
  • Macy's
  • New York, NY
  • Job Description About Macy's is proudly America's Department Store. For more than 160 years, Macy's has served generatio...
  • 3/18/2024 12:00:00 AM

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Technical Specialist 2
  • Metropolitan Transportation Authority
  • New York, NY
  • Description Position at MTA Construction & Development This position is eligible for telework which is currently one day...
  • 3/17/2024 12:00:00 AM

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Senior Technical Specialist 1 (Telecommunications)
  • Metropolitan Transportation Authority
  • New York, NY
  • Description Position at MTA Construction & Development This position is eligible for telework, which is currently one da...
  • 3/17/2024 12:00:00 AM

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TECHNICAL SPECIALIST
  • eTeam, Inc.
  • Franklin Lakes, NJ
  • To have strong skills in implementing the JDE E1 Manufacturing module. The consultant will evaluate customers' functiona...
  • 3/15/2024 12:00:00 AM

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Technical Specialist
  • Barnard College
  • New York, NY
  • If you are a current Barnard College employee, please use the internal career site to apply for this position. Job: Tech...
  • 3/15/2024 12:00:00 AM

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HVAC/R Technical Specialist
  • DG Partnership
  • New York, NY
  • Job Description Job Description HVAC/R Technical Support Specialist – Competitive Salary – USA (Remote) The Role Can you...
  • 3/14/2024 12:00:00 AM

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Senior Technical Specialist 3
  • Metropolitan Transportation Authority
  • New York, NY
  • Description Position at MTA Construction & Development This position is eligible for telework, which is currently one da...
  • 3/14/2024 12:00:00 AM

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Senior Technical Specialist Level 2 (CADD)
  • Metropolitan Transportation Authority
  • New York, NY
  • Description Position at MTA Construction & Development Job Posting This position is eligible for telework, which is curr...
  • 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 Technician jobs
$70,680 to $98,624
Somerset, New Jersey area prices
were up 1.5% from a year ago

Utilization Review Technician in Winston Salem, NC
When considering cost of living, this places Durham, NC as 3rd out of the 4 largest nearby metros in terms of quality of life for Utilization Review Technicians**.
January 02, 2020
Utilization Review Technician in Fairbanks, AK
Current National Pharmacy Technician Certification (PTCB, ExCPT or NCCT) required.
February 03, 2020
Utilization Review Technician in Little Rock, AR
Based on our compensation data, the estimated salary potential for Utilization Review Technician will increase 16 % over 5 years.
February 07, 2020