About this role
About the Role The Utilization Management Coordinator conducts utilization reviews to ensure that clinical services meet medical necessity and all applicable standards for regulatory funding and accreditation within Rutgers University Behavioral Health Care. This role supports compliance, appropriate resource use, and quality across behavioral health services. What You'll Do
- Conduct utilization reviews to determine medical necessity and adherence to regulatory funding and accreditation standards.
- Review clinical documentation and service utilization to ensure compliance and support appropriate resource allocation.
- Collaborate with clinical teams to obtain necessary information and finalize determinations; maintain accurate records and reporting.
- Communicate findings and recommendations to care teams and supervisors.
- Participate in internal audits and quality assurance activities. What We're Looking For
- Experience in utilization management or related healthcare field; knowledge of medical necessity criteria and regulatory funding/accreditation processes.
- Strong analytical and problem-solving skills; attention to detail.
- Excellent written and verbal communication and collaboration with multidisciplinary teams.
- Ability to handle confidential information and maintain compliance with privacy and policy.