Position DetailsPosition Information
Recruitment/Posting Title Utilization Management Coordinator UCHC
Job Category Staff & Executive - Healthcare - Administrative Services
Department UCHC Administration
Posting Summary Rutgers University Correctional Health Care (UCHC) is seeking a Utilization Management Coordinator located in the central administration offices located in Trenton, NJ. The Utilization Management Coordinator performs utilization reviews for medical services provided by hospitals and other auxiliary medical services. Negotiates re-pricing charges for hospital and other auxiliary medical services.
Duties include:
- Performs utilization/quality improvement reviews in accordance with established quality management procedures.
- Performs clinical/medical reviews for all changes in levels of care based on medical necessity criteria, continued length of stay reviews, and discharge follow up for all levels of care.
- Identifies pertinent clinical information necessary to certify admission and continued lengths of stay and or coordinate transfer back to NJDOC infirmary services and to evaluate quality of care in accordance with pre-established criteria.
- Consults with Statewide Medical Director/designee on all complex cases or continued stay issues.
- Assesses each patient being reviewed for high-risk status (multiple medical problems/multiple hospital admissions) and arranges as necessary clinical follow up on all identified high-risk patients.
- Performs data entry of assigned cases in a timely manner.
- Maintains close interaction with internal and external customers in a professional manner.
- Communicates in a professional and courteous manner.
- Works closely with medical personnel, billing, patient accounting, and utilization management departments of hospitals and other healthcare entities to maximize health care delivery within the prison system and minimize expenses for ancillary medical care and hospitalization while meeting the medically necessary medical treatment of the inmates.
- Develops and manages the existing UCHC provider network.
- Develops and maintains relationships with healthcare providers required to supplement the health care network available directly through UCHC within NJDOC facilities to assure inmates have access to medically necessary medical treatment.
- Minimizes the delivery of any healthcare by another healthcare entity that could be provided within the existing health care system within NJDOC.
- Obtains clinical information to substantiate medical necessity by reviewing patient charts, attending department rounds and treatment planning, and by talking to physicians and other healthcare providers.
FLSA Exempt
Grade 25S
Salary DetailsMinimum Salary 71162.000
Mid Range Salary 85428.000
Maximum Salary 101456.000
Offer Information The final salary offer may be determined by several factors, including, but not limited to, the candidate's qualifications, experience, and expertise, and availability of department or grant funds to support the position. We also take into consideration market benchmarks, if and when appropriate, and internal equity to ensure fair compensation relative to the university's broader compensation structure. We are committed to offering competitive and flexible compensation packages to attract and retain top talent.
Benefits Rutgers provides a comprehensive benefits package to eligible employees. The specific benefits vary based on the position and may include:
- Medical, prescription drug, and dental coverage
- Paid vacation, holidays, and various leave programs
- Competitive retirement benefits, including defined contribution plans and voluntary tax-deferred savings options
- Employee and dependent educational benefits (when applicable)
- Life insurance coverage
- Employee discount programs
Position Status Full Time
Working Hours 40
Standard Hours 40.00
Daily Work Shift Day
Work Arrangement This position requires a full onsite work arrangement.
Union Description HPAE 5094
Payroll Designation PeopleSoft
Seniority UnitTerms of Appointment Staff - 12 month
Position Pension Eligibility ABP
Qualifications
Minimum Education and ExperienceCertifications/LicensesRequired Knowledge, Skills, and Abilities - Bachelor of Nursing (BSN) or bachelor's degree in related clinical field (LCSW, LFC, Psychology). Additional related experience may be substituted for the degree on a year-for-year basis.
- A minimum of two (2) years of related experience
- Minimum of one (1) year of experience in a correctional setting preferred. CPR Certification
- Computer literacy.
- Valid driver's license is required. Possesses own vehicle or alternative means of transportation from one site to another.
Preferred Qualifications - Minimum of one (1) year of experience as a Utilization Review Nurse is highly desirable.
Equipment UtilizedPhysical Demands and Work EnvironmentSpecial Conditions Must be approved by the Department of Corrections (DOC) and adhere to all DOC requirements.
Posting Details
Posting Number 26ST1850
Posting Open DateSpecial Instructions to ApplicantsRegional Campus Rutgers Biomedical and Health Sciences (RBHS)
Home Location Campus Off Campus
City Trenton
State NJ
Location DetailsPre-employment Screenings
All offers of employment are contingent upon successful completion of all pre-employment screenings.
Immunization Requirements
Under Policy 100.3.1 Immunization Policy for Covered Individuals, if employment will commence during Flu Season, Rutgers University may require certain prospective employees to provide proof that they are vaccinated against Seasonal Influenza for the current Flu Season, unless the University has granted the individual a medical or religious exemption. Additional infection control and safety policies may apply. Prospective employees should speak with their hiring manager to determine which policies apply to the role or position for which they are applying. Failure to provide proof of vaccination for any required vaccines or obtain a medical or religious exemption from the University will result in rescission of a candidate's offer of employment or disciplinary action up to and including termination.
