Essential Duties and Responsibilities

• Reviews admissions, continued stays, and discharges to determine if they are consistent with established criteria. If criteria are not met, notifies Attending Physician. Reports statistics to professional staff and committees.
• Assures that person's expressed needs and strengths drive service plan and service delivery.
• Conducts certification, pre-certification, and continuing certification requirements for Medicaid, Medicare, and insurance clients.
• Communicates routinely with Financial Services staff regarding specific reimbursement issues and integrates reports to University Behavioral Health Care's Manager, Patient Financial Services.
• Ensures that insurance information is current with background investigation if no insurance card available.
• Performs data entry of assigned cases in a timely manner, evidenced by supervisory review.
• Assesses and follows up on patients re-admitted within 30 days, within pre-established timeframes, as noted by supervisor.
• Notifies each Physician/Advanced Practice Nurse when continued certification is not approved and reports this to the appropriate committee.
• Determines if appeal should be instituted after discussion with specific staff and writes appeal.
• Reports statistics to Unit Services Chief, Utilization Review Committee.
• Demonstrates knowledge of the four Behavioral Health National Patient Safety goals and assures compliance in the delivery of care:
  • Consumer/Patient identification: Use of two consumer/patient identifiers.
  • Reduce the risk of health care-associated infections/comply with hand hygiene guidelines.
  • Medication Reconciliation.
  • Identification of consumer/patient at risk.
• Contributes to and supports the mission, vision, values, goals, and objectives of University Behavioral Health Care.
  • Demonstrates knowledge of University Behavioral Health Care's vision, mission, and values as these relate to daily activities, decisions, and quality improvement priorities.
  • Actively participates and makes positive contributions to University Behavioral Health Care wide meetings, committees, and task forces as assigned.
  • Actively and enthusiastically participates in and contributes to smooth functioning and operations of unit.
  • Actively participates in Program Improvement (PI) initiatives.
• Meets annual requirements:
  • Completes Annual Employee Health Update (to include PPD).
  • Completes all mandatory educational requirements on an annual basis.
  • Provides Accreditation and Standards Department and Human Resources copies of any degree requirements, new licenses, or new credentials acquired over the last year.
• Understands and adheres to Rutgers' compliance standards as they appear in RBHS's Corporate Compliance Policy, Code of Conduct, and Conflict of Interest Policy.
• Keeps abreast of all pertinent federal, state, and Rutgers' regulations, laws, and policies as they presently exist and as they change or are modified.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Registered nurse with a license to practice in the State of New Jersey or a Bachelor's Degree in the Mental Health field (LCSW, LPC, Psychology).
• Must have at least three (3) years of mental health experience. Candidates with a Bachelor's Degree may have a minimum of two (2) years of experience.
• Utilization review experience either working for providers or with third party payers highly preferred.
• Data entry/computer skills preferred.
• Equivalent combination of education, experience, and/or training to perform the duties.

Credentials Required: If a nurse, Registered Nurse.

Primary Source Verification: New Jersey Division of Consumer Affairs (nurse), Board of Nursing (nurse) and the University approved verification service (all).

Work requires regular and recurring periods of standing, walking, and lifting.

Work will be performed in a wide range of settings, including within University Behavioral Health Care; in the consumer's home; in community-based settings; or in transport vehicles. Consumers can present with active psychiatric symptoms, mixed responses to interventions, and unstable living and relationship situations. Fast-paced environment that demands ability to attend to multiple consumer needs and provide crisis intervention when indicated. Work areas may be noisy, irregular and unpredictable and can be stressful at times.

Equiliem Healthcarespecializes in staffing clinical, non-clinical, and allied personnel. We excel in all levels, disciplines, and specialties within the healthcare spectrum. Our projects range from short-to-long-term local and travel assignments. Equiliem has been recognized as a certified small business enterprise. In addition, we are proud that we have earned the prestigious Joint Commission accreditation for staffing firms and have been awarded Best in Staffing 4 years running by our employees and client partners.

Benefits offered to our workers include the following:

• Medical Insurance
• Vision & Dental insurance
• Life Insurance
• 401K
• Commuter Benefits
• Employee Discounts & Rewards
• Payroll Payment Options

We are committed to providing equal employment opportunities to all employees and applicants without regard to race, religion, color sex, national origin, citizenship status, age, sexual orientation, gender identity, marital status, uniform service member status, genetic information, disability, or any other protected status, in accordance with all applicable federal, state, and local laws. This practice extends to all aspects of our employment practices, including but not limited to, recruiting, hiring, firing, promoting, transferring, compensation, benefits, training, leaves of absence, and other terms and conditions of employment.