HOSPITAL UTILIZATION REVIEW COORDINATOR
To land Hospital Utilization Review Coordinator in New Jersey you go through the competitive route: you sit an announced exam and the score puts you on the eligible list agencies hire from.
To be eligible you bring 2 years of relevant experience and a professional license.
How to apply
This title is filled by competitive examination.
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Hospital Utilization Review Coordinator is a local service title. It is filled by the counties, municipalities, authorities and other employers that have adopted civil service under Title 11A, not by State departments. Those employers set pay by ordinance or contract rather than from a State salary schedule, which is why most local titles carry no salary range here.
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Official job specification
The text below is the official specification published by the New Jersey Civil Service Commission. The plain-language summary and analysis above are derived from it by NJ Civil Service Navigator. Source: the official specification page at NJ CSC.
Definition
Under direction of the Utilization Review Committee and Medical Director, assists in the utilization review and evaluation of patients to ensure high quality patient care and to promote optimum use of hospital beds, facilities, and programs, and coordinates discharge planning; does related work as required.
Examples of work
- On admission interviews patients, reviews records, and makes recommendations for certification in accord with hospital criteria.
- Maintains a time schedule for recertification of patients.
- Interviews inpatients in conjunction with medical staff and nursing staff, and collects and records all information and data needed to recertify extended stay at proper level of care.
- Reviews all cases where the necessity of extended stay is questioned and reports on findings.
- In conjunction with medical records, compiles and maintains statistical data on patient stay and care to improve, revise, and update hospital criteria.
- Checks patient data on utilization review form for completeness and conformity to specific criteria.
- Reviews patient charts for completion and to ensure followup as prescribed by doctor.
- Brings to the attention of the utilization review committee or medical director any irregularities in patient care.
- Ensures completion of certification and recertification forms to third party intermediary.
- Attends utilization review committee and administrative meetings, keeps minutes, presents topics for discussion, and keeps medical staff informed of government requirements.
- Maintains effective liaison with the nursing division, social service division, medical records, hospital administration, and inservice education division to ensure continuity of patient care and effective patient communication.
- Coordinates discharge planning to effect a smooth patient discharge or transfer either to another facility or to a home care program.
- Assists the utilization review committee in preparing and disseminating reports, medical care evaluation studies, and other related functions.
- Organizes and assigns work to other employees engaged in utilization review activities.
- Will be required to learn to utilize various types of electronic and/or manual recording and computerized information systems used by the agency, office, or related units.
Experience
Two (2) years of experience as a general duty nurse, one (1) year of which shall have been in a supervisory capacity.
License
Current and valid registration as a professional nurse in the State of New Jersey.
Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform the essential duties of the position.
Knowledge, skills and abilities
- Knowledge of objectives, principles, and methods of professional nursing.
- Knowledge of medicare and medicaid regulations and requirements.
- Knowledge of modern hospital and institutional organization and administration and the laws applicable to hospital operations.
- Knowledge of administrative problems involved in meeting government requirements for patient care, optimum use of hospital beds, and discharge planning.
- Knowledge of conducting surveys, compiling statistical information, and preparing reports.
- Knowledge of preparation and maintenance of accurate medical and other records.
- Ability to organize assigned work and develop effective work methods.
- Ability to interpret rules and regulations of different government agencies.
- Ability to give assignments and instructions.
- Ability to work effectively and harmoniously with department heads, professional staff, associates, and representatives of other agencies.
- Ability to conduct surveys, compile statistical information, and prepare reports containing findings, conclusions, and recommendations.
- Ability to speak and write effectively.
- Ability to maintain essential records and files.
- Ability to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.
- Ability to read, write, speak, understand, or communicate in English sufficiently to perform the duties of this position. American Sign Language or Braille may also be considered as acceptable forms of communication.
- Persons with mental or physical disabilities are eligible as long as they can perform the essential functions of the job after reasonable accommodation is made to their known limitations. If the accommodation cannot be made because it would cause the employer undue hardship, such persons may not be eligible.
Note
The definition and examples of work for this title are for illustrative purposes only. A particular position using this title may not perform all duties listed in this job specification. Conversely, all duties performed on the job may not be listed.