Physician Utilization Review Specialist Per Diem HUMC

3 weeks ago


Hackensack, Minnesota, United States Hackensack Meridian Health Full time

Job Summary:

The Senior Utilization Review Specialist collaborates with the healthcare team to ensure the integrity of clinical records for patients and Hackensack UMC. This role involves utilization review, hospital reimbursement, clinical compliance, case management, and transitions of care.

Key Responsibilities:

  • Regulatory compliance
  • Provides direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation
  • Liaison to the Medical Staff supporting Utilization Management Committee processes
  • Hospital Based Appeals Management
  • Provides guidance and interpretation on issues of medical appropriateness and level of care needs

Education and Experience:

  • Medical degree from a recognized Medical School
  • Completion of a residency program from an accredited medical institution
  • Minimum of 3 years medical practice experience

Licenses and Certifications:

  • Medical Doctor License
  • Maintains at least one Medical Board Certification

Working Environment:

Regular contact with Medical Center personnel, patients and visitors.



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