Utilization Management Coordinator

About the role

Rutgers University Behavioral Health Care (UBHC), established in 1971, offers a full continuum of evidence‑based behavioral health and addiction services for children, adolescents, adults, and seniors throughout New Jersey. UBHC’s 1,060 experienced behavioral health professionals and support staff are dedicated to treatment, prevention, and education. UBHC, one of the largest providers of behavioral health care in the country, has a budget of $260 million and 15 sites throughout New Jersey. Services include inpatient, outpatient, partial hospitalization, screening, crisis stabilization, family/caregiver support, community outreach and case management, supportive housing, supported employment, prevention and consultation, employee assistance programs, and a licensed therapeutic school from preschool through high school. Specialty services include the New Jersey suicide prevention helpline and peer help lines for police, veterans, active military, teachers, mothers of special‑needs children, and child protective service workers. In FY2016, UBHC treated 16,199 consumers, had 24,502 admissions, and touched the lives of 19,441 individual callers through peer support. UBHC is also the primary mental health training resource for the New Jersey Departments of Human Services, Children and Families, and Corrections, delivering 16,000 trainings each year.

Responsibilities

• Review admissions, continued stays, and discharges to determine consistency with established criteria; refer cases requiring additional expertise to the UR Supervisor.
• Notify the UR Supervisor when criteria are not met.
• Conduct certification, pre‑certification, and continuing certification for Medicaid, Medicare, and insurance clients.
• Communicate outcomes of pre‑certification and concurrent reviews to treatment team members, leadership, and the UR Supervisor.
• Communicate routinely with the UR Supervisor regarding specific reimbursement issues.
• Serve as a resource for the treatment team on medical necessity interventions and documentation.
• Assist treatment team members in discharge planning and obtaining authorization for the next level of care as needed.
• Participate in data collection related to patient status and needs.
• Identify and report quality‑of‑care issues or concerns to the supervisor.
• Ensure insurance information is current; conduct background investigation if no insurance card is available.
• Perform timely data entry of assigned cases.

Qualifications

Minimum Education and Experience

• Registered Nurse with a license to practice in the State of New Jersey or a Bachelor’s Degree in the Mental Health field.
• At least three (3) years of mental health experience.

Certifications / Licenses

• Registered Nurse license (New Jersey).
• Applicants with a Social Work degree must hold an active New Jersey certification/licensure as required by the State Board of Social Work.

Required Knowledge, Skills, and Abilities

Utilization review experience (either working for providers or with third‑party payers) is highly preferred. Data entry and computer skills are preferred.

Benefits

• 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

Pay

Salary range (Grade 25S, FLSA Exempt):

• Minimum: $71,162
• Mid‑range: $85,428
• Maximum: $101,456

The final salary offer may be determined by the candidate’s qualifications, experience, expertise, availability of department or grant funds, market benchmarks, and internal equity considerations.

Schedule

• Full‑time position
• Working hours: 28 hours per week (standard hours: 37.50)
• Daily work shift: consistent with Rutgers Policy 60.3.22 or applicable collective negotiations agreements; may be eligible for a hybrid work arrangement (subject to approval in the FlexWork@RU Application System, not permanent, and may change or be discontinued).

Physical Demands and Work Environment

Physical Demands

• Extensive reading required
• Lifting up to 10 pounds
• Extended periods of sitting
• Walking throughout the day
• Standing for extended periods
• Some driving to various locations throughout New Jersey for meetings

Work Environment

• Moderate noise (business office with computers and printers, light traffic)
• Subject to unpredictable situations, patient crises (both medical and psychiatric)
• Occasionally exposed to patients exhibiting assaultive behaviors