Job Details

Overview

How have you impacted someone's life today? At Hackensack Meridian Health our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career, all within New Jersey's premier healthcare system.

Responsibilities

Review Activities:  Admission review, admission denial, continued stay review, continued stay denial, termination of benefits, communication of information to insurance company, billing certification, concurrent managed care, Denial Appeals, retrospective medical record utilization review. 

Obtains and evaluates medical records for in patient admissions to determine if required documentation is present. 

Obtains appropriate records as required by payer agencies and initiates physician advisor's as necessary for unwarranted admissions.  Conducts on going review and discusses care changes with attending physicians and others. 

Performs chart reviews for appropriateness of admission and continued hospital stay applying appropriate clinical criteria.   Performs admission review within 24 hours or the first business day.

Refers cases not meeting criteria to the physician advisor for determination and action.

Qualifications

•  RN BSN preferred 
• Certified Case Manager preferred

• Active American Heart Association (AHA) BLS/CPR certification is required

• Licensed as a Registered Nurse in the state of New Jersey required
• Minimum of five years experience in the acute care setting required
• Previous case management/utilization review experience preferred
• Knowledge of InterQual/Milliman criteria and other guidelines for medical necessity, appropriate level of care and concurrent patient management
• Knowledge of health care delivery system, utilization review and case review procedures
• Computer skills to include Microsoft Word, Excel and basic data entry
• Strong organizational and problem solving skills
• Excellent oral, written and interpersonal skills

Our Network

Hackensack Meridian Health (HMH) is a Mandatory COVID-19 and Influenza Vaccination Facility

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.