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Utilization Review Assistant Jobs in Edison, NJ (NOW HIRING)

SVCMC Inc

Transition of Care Nurse Care Manager

Manhattan, NY · On-site

$95K - $100K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Provide education to physicians, care managers and other members of the team on the issues related to utilization review including inappropriate admissions and placements. * Assist hospital staff in ...

Odyssey House INC

Assistant Program Director

Manhattan, NY · On-site

$75K - $95K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization review process through coordination and collaboration with UR Specialist. 8. ... Ability Assist Counseling Services (through The Hartford) * Commuter Benefits * Educational ...

Hudson Regional Hospital

RN Case Manager

Secaucus, NJ · On-site

$100K - $110K/hr

Acts as liaison to assist in identifying opportunities to improve care. * Keeps Director of Case ... Knowledge of Utilization Review criteria to include Interqual and/or Milliman preferred.

Hudson Regional Hospital

RN Case Manager

Secaucus, NJ · On-site

$90K - $100K/yr

Acts as liaison to assist in identifying opportunities to improve care. * Keeps Director of Case ... Knowledge of Utilization Review criteria to include Interqual and/or Milliman preferred.

CenterLight TeamCare

SITE PHYSICIAN ASSISTANT

New York, NY · On-site

$109K - $148K/yr

Develops and participates in the Utilization Review of medical services provided by the IDT/DTC ... Graduate of an accredited Physician Assistant Program. * Diploma in Geriatric Medicine or ...

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All JobsUtilization Review JobsUtilization Review Assistant JobsUtilization Review Assistant Jobs in Edison, NJ

Utilization Review Assistant information

What is a utilization review assistant?

A Utilization Review Assistant supports the utilization review process by reviewing medical records, verifying insurance coverage, and ensuring that healthcare services meet necessary guidelines. They assist in gathering documentation, communicating with insurance providers, and coordinating with medical staff to facilitate approvals for treatments. Their role helps ensure that healthcare services are provided efficiently while maintaining compliance with insurance policies and regulations.

What does a utilization review assistant do?

A Utilization Review Assistant typically spends their day reviewing medical records, verifying patient information, and ensuring documentation meets insurance or regulatory requirements. They often work closely with nurses, physicians, case managers, and billing staff to collect necessary data and clarify documentation. The work is usually performed in an office within a hospital, clinic, or insurance company, where prioritizing tasks and maintaining confidentiality are key. This collaborative, detail-oriented environment provides a valuable introduction to healthcare administration and can open doors to broader roles in utilization management or case management.

What skills and qualifications are needed to be a utilization review assistant?

To thrive as a Utilization Review Assistant, you need attention to detail, basic understanding of medical terminology, strong organizational skills, and typically a high school diploma or equivalent. Familiarity with healthcare management software and electronic health records (EHR) systems, along with experience in data entry, is important for this role. Strong communication, problem-solving abilities, and a customer service-oriented attitude help you excel when interacting with clinical staff and patients. These skills are essential for ensuring accurate review processes, compliance with regulations, and effective coordination within healthcare teams.

How do I get into a utilization review assistant?

To become a utilization review assistant, candidates typically need a high school diploma or equivalent, with some roles preferring healthcare-related certifications or experience. Strong organizational skills, attention to detail, and familiarity with medical records and insurance processes are important; some positions may require knowledge of healthcare management software. Gaining relevant experience or certifications can improve job prospects in this field.

What are the most commonly searched types of Utilization Review jobs in Edison, NJ?

The most popular types of Utilization Review jobs in Edison, NJ are:

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For Utilization Review Assistant jobs in Edison, NJ, the most frequently searched job titles are:

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Utilization Review Assistant jobs near you

Transition of Care Nurse Care Manager

SVCMC Inc

Manhattan, NY • On-site

$95K - $100K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 8 days ago

Job description

JOB SUMMARY

A Transitional Care Nurse oversees the care of a patient as they move from one health care facility, such as a hospital or nursing home, to another facility or their home. The transitional care nurse ensures the relocation is as smooth as possible and helps the patient remain comfortable during the change. The transitional care model (TCM) of health care aims to reduce disruption in care, and thus lower the chances of patients relapsing and having to return to the hospital.


RESPONSIBILITIES

  • Coordinate discharge planning with the inpatient member’s clinical team at admission and will follow through to ensure safe discharge.
  • Coordinates with our utilization management team to review clinicals to ensure the member is progressing well and to determine an appropriate discharge plan. This includes but is not limited to ensuring a follow up is made with appropriate health care providers, ensuring members have access to prescribed medications, and that the member has adequate resources and equipment to meet their needs once the Member transitions to the community.
  • Act as a patient advocate by negotiating for and coordinating resources with payers, agencies and vendors as appropriate.
  • Provide education to physicians, care managers and other members of the team on the issues related to utilization review including inappropriate admissions and placements.
  • Assist hospital staff in creating the discharge plan that will address identified needs and barriers to support a smooth recovery; assess if the member can be discharged.
  • Conduct outreach and engagement post hospitalization, E.R visit or Skilled Nursing stay within 24 hours after Member’s discharge to assist members with medication reconciliation, medication compliance and to ensure member follows up with MD within a week after discharge.
  • Documents progress notes regarding member’s condition and documents communications as it pertains to Member’s discharge plan in USFHP computer data base.


EXPERIENCE

  • Minimum 2 years of Medical Surgical experience.
  • Utilization review processes.
  • Discharge planning and case management experience.


Skills/Competencies

  • Flexible and willing to work in a dynamic and evolving role according to individual Members and program demands.
  • Proactive team player.
  • Strong follow through.
  • Quick decision-making abilities.
  • Strong problem solver.
  • Experience in UM review.


Education/Certifications/License

  • Bachelor’s Degree Required
  • Must possess a current and unrestricted NYS RN License and Registration.
  • Must be able to obtain RN Licenses in our areas of service CT, PA, and NJ.


SALARY RANGE: $95,000.00 to $100,000.00


Benefits Statement

SVCMC, Inc. provides a robust benefits package that includes medical coverage through UnitedHealthcare/Oxford with no deductible for in-network services. Employees also receive vision coverage through UnitedHealthcare Vision and dental benefits through MetLife. Basic life and disability insurance are automatically provided at no cost. All employees are eligible for commuter benefits, tuition reimbursement, and a 401(k)retirement plan with an immediate employer match that is fully vested from day one. SVCMC also offers a generous time off package, which includes vacation, 10 paid holidays, and 3 personal days. Additionally, employees have access to a comprehensive Employee Assistance Program and exclusive discounts through Working Advantage.


SVCMC IS AN EQUAL OPPORTUNITY EMPLOYER - ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO VETERAN STATUS, DISABILITY, OR OTHER CHARACTERISTICS PROTECTED BY LAW.


HYBRID - Mondays & Fridays Remote
Tuesdays through Thursdays In-Office
9 am - 5 pm