Registered Nurse Utilization Management Behavioral
2 weeks ago
**TITLE: Utilization Management Nurse Behavioral Health**
**JOB CODE: #** 7073
**EXEMPT**: X
**NON-EXEMPT**:
**DATE: 03/23**
**REVISED:
- Graduate of an accredited school of nursing required.
- Current licensure as a nurse in the State of New Jersey/ or compact licensed with New Jersey
***
**The Utilization Management Behavioral Health is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical information to determine the appropriate level of care assignment, along with the **completion and submission of reviews to insurance payers with appropriate follow-up. **The Utilization Management staff u**tilizes designated criteria/guidelines to determine and document the medical necessity and appropriate level of care. This position a**nalyzes clinical information received to facilitate authorization from insurance providers, maximize reimbursement by preventing denials, and ensures clinical data is sufficient to obtain an authorization. This position ensures that the obligation for clinical review is met according to the payer contracts and validates the accuracy of insurance information in the system. The Utilization Management staff is knowledgeable of the payer contracting arrangements, admission notification and clinical review requirements, as well as the regulatory and compliance requirements for government payers regarding clinical reviews and medical necessity. This role ensures that appropriate and accurate information is placed into the patient accounting system for processing of payment. This role also provides notification of denial issues and potential avoidance of a denial, along with changes in insurance information to all appropriate areas (e.g. clinical team, Patient Accounting). The Utilization Management staff supports Behavioral Health Service Line improvement initiatives within ambulatory, hospitals and the medical staff structure to ensure effective and timely performance improvement. This role Participates in UR Committee work as requested.**
***
**Q**UALIFICATIONS**
**EDUCATION**: Graduate of an accredited school of nursing required. RN or LPN. Bachelor's in nursing preferred. Case Management certification preferred.
**LICENSE/CERTIFICATION**: Current licensure as a nurse in the State of New Jersey/ or compact licensed with New Jersey
**EXPERIENCE**: Prior case management/insurance case management experience preferred. Proficiency in Clinical Applications preferred at time of hire; incumbents within position will be trained appropriately and then skill will be required for this position within 30-60 days from date of hire.
***
**PERFORMANCE EXPECTATIONS**
Demonstrates the technical competencies as established on the Assessment and Evaluation Tool.
***
**WORK ENVIRONMENT**
This position requires desk/computer work a majority of the time. There is some standing, walking and occasional lifting up to 20 pounds. The essential functions for this position are listed on the Assessment and Evaluation Tool.
**REPORTING RELATIONSHIP**
This position reports to department leadership.
**The above statement reflect the general details considered necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.
-
Egg Harbor Township, United States Atlanticare Regional Medical Center Full timeRegistered Nurse Utilization Management Behavioral Health - Full TimeTITLE: Utilization Management Nurse Behavioral Health JOB CODE: # 7073 EXEMPT: X NON-EXEMPT: DATE: 03/23 REVISED: * Graduate of an accredited school of nursing required. * Current licensure as a nurse in the State of New Jersey/ or compact licensed with New Jersey POSITION...
-
Egg Harbor Township, United States AtlantiCare Full timeJob Description TITLE: Utilization Management Nurse Behavioral Health JOB CODE: # 7073 EXEMPT: X NON-EXEMPT: DATE: 03/23 REVISED: Graduate of an accredited school of nursing required. Current licensure as a nurse in the State of New Jersey/ or compact licensed with New Jersey POSITION SUMMARY The Utilization Management...
-
Registered Nurse
4 weeks ago
Egg Harbor Township, United States Atlanticare Regional Medical Center Full timeRegistered Nurse - Utilization Management - Full Time* Graduate of an accredited school of nursing required. * Current licensure as a Registered Nurse in the State of New Jersey POSITION SUMMARY The RN Utilization Management Days is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical...
-
Registered Nurse
3 weeks ago
Egg Harbor Township, United States Atlanticare Regional Medical Center Full timeRegistered Nurse - Utilization Management - Full Time* Graduate of an accredited school of nursing required. * Current licensure as a Registered Nurse in the State of New Jersey POSITION SUMMARY The RN Utilization Management Days is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical...
-
Registered Nurse
1 week ago
Egg Harbor Township, United States AtlantiCare Full timeGraduate of an accredited school of nursing required. - Current licensure as a Registered Nurse in the State of New Jersey *** **The RN Utilization Management Days is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical information to determine the appropriate level of care assignment,...
-
Egg Harbor Township, NJ, United States Atlanticare Regional Medical Center Full timeRegistered Nurse Utilization Management Behavioral Health - Full TimeTITLE: Utilization Management Nurse Behavioral Health JOB CODE: # 7073 EXEMPT: X NON-EXEMPT: DATE: 03/23 REVISED: * Graduate of an accredited school of nursing required. * Current licensure as a nurse in the State of New Jersey/ or compact licensed with New Jersey POSITION...
-
Egg Harbor Twp, United States AtlantiCare Full timeJob DescriptionTITLE: Utilization Management Nurse Behavioral HealthJOB CODE: # 7073 EXEMPT: X NON-EXEMPT:DATE: 03/23REVISED: Graduate of an accredited school of nursing required. Current licensure as a nurse in the State of New Jersey/ or compact licensed with New JerseyPOSITION SUMMARY The Utilization Management Behavioral Health is responsible for the...
-
Registered Nurse
4 weeks ago
Egg Harbor Township, NJ, United States Atlanticare Regional Medical Center Full timeRegistered Nurse - Utilization Management - Full Time * Graduate of an accredited school of nursing required. * Current licensure as a Registered Nurse in the State of New Jersey POSITION SUMMARY The RN Utilization Management Days is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical...
-
Registered Nurse
3 weeks ago
Egg Harbor Twp, United States AtlantiCare Full timeRegistered Nurse - Utilization Management - Full Time Graduate of an accredited school of nursing required. Current licensure as a Registered Nurse in the State of New Jersey POSITION SUMMARY The RN Utilization Management Days is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical...
-
Registered Nurse
4 weeks ago
Egg Harbor Township, NJ, United States Atlanticare Regional Medical Center Full timeRegistered Nurse - Utilization Management - Full Time* Graduate of an accredited school of nursing required. * Current licensure as a Registered Nurse in the State of New Jersey POSITION SUMMARY The RN Utilization Management Days is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical...
-
Registered Nurse
3 weeks ago
Egg Harbor Township, NJ, United States Atlanticare Regional Medical Center Full timeRegistered Nurse - Utilization Management - Full Time* Graduate of an accredited school of nursing required. * Current licensure as a Registered Nurse in the State of New Jersey POSITION SUMMARY The RN Utilization Management Days is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical...
-
Registered Nurse
3 weeks ago
Egg Harbor Twp, United States AtlantiCare Full timeJob DescriptionGraduate of an accredited school of nursing required.Current licensure as a Registered Nurse in the State of New JerseyPOSITION SUMMARY The RN Utilization Management Days is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical information to determine the appropriate level...
-
Registered Nurse
3 weeks ago
Egg Harbor Twp, United States AtlantiCare Full timeJob DescriptionGraduate of an accredited school of nursing required.Current licensure as a Registered Nurse in the State of New JerseyPOSITION SUMMARY The RN Utilization Management Days is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical information to determine the appropriate level...
-
Egg Harbor Township, United States AtlantiCare Full timeJob DescriptionPosition:Physician Advisor, Clinical Documentation Improvement Utilization ManagementPRIMARY SCOPE OF SERVICE: The Physician Advisor CDI/UM works closely with the medical staff leadership, the entire medical staff, including resident physician house staff, and coding and CDI to ensure physician clinical documentation is accurate and complete...
-
Egg Harbor Township, United States AtlantiCare Full timeJob DescriptionPosition:Physician Advisor, Clinical Documentation Improvement Utilization ManagementPRIMARY SCOPE OF SERVICE: The Physician Advisor CDI/UM works closely with the medical staff leadership, the entire medical staff, including resident physician house staff, and coding and CDI to ensure physician clinical documentation is accurate and complete...
-
Registered Nurse
4 weeks ago
Egg Harbor Township, United States DOCS Health Full timeJob DescriptionJob DescriptionDescription:Attention all Registered Nurses, we are calling you to partner with us as independent contractors providing services to our Military Service members. We primarily work weekends, with some occasional weekdays under the Reserve Health Readiness Program (RHRP) in the State of New Jersey on an "as needed basis". We...
-
Registered Nurse
3 weeks ago
Egg Harbor Township, United States DOCS Health Full timeJob DescriptionJob DescriptionDescription:Attention all Registered Nurses, we are calling you to partner with us as independent contractors providing services to our Military Service members. We primarily work weekends, with some occasional weekdays under the Reserve Health Readiness Program (RHRP) in the State of New Jersey on an "as needed basis". We...
-
Program Supervisor
4 weeks ago
Egg Harbor Township, United States Behavioral Crossroads Full timeJob DescriptionJob DescriptionBehavioral Crossroads, LLC is seeking a full-time Program Supervisor to join our partial care team! The Program Supervisor is responsible for assisting in the intake process for all new clients in the Behavioral Crossroads Mental Health Partial Care program and the Behavioral Health Home program. This includes engaging clients...
-
Program Supervisor
3 weeks ago
Egg Harbor Township, United States Behavioral Crossroads Full timeJob DescriptionJob DescriptionBehavioral Crossroads, LLC is seeking a full-time Program Supervisor to join our partial care team! The Program Supervisor is responsible for assisting in the intake process for all new clients in the Behavioral Crossroads Mental Health Partial Care program and the Behavioral Health Home program. This includes engaging clients...
-
Manager, Nursing RN
4 weeks ago
Egg Harbor Township, NJ, United States Atlanticare Regional Medical Center Full timeRegistered Nurse - Utilization Management - Full Time * Graduate of an accredited school of nursing required. * Current licensure as a Registered Nurse in the State of New Jersey POSITION SUMMARY The RN Utilization Management Days is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical...
