Princeton House Behavioral Health is searching for a Utilization Mgmt Reviewer for our Moorestown, NJ location.
Conducts Utilization Management reviews for Princeton House patients, assigned by the Department Director. Documents in the facility-wide computer system the results of each review, conducted both internally and externally (with managed care organizations). Familiarity with Princeton House services/programs in all locations is essential.
Job responsibilities can include, but are not limited to:
- Perform admission review for assigned patients to determine the medical necessity and appropriateness of admission based on departmental policy and procedure
- Maintain system for monitoring admissions to assure the review of extended stay and communication of such information to insurance providers/managed care companies in a timely fashion. Maintains a schedule of additional review dates for patients requiring concurrent review. This information is to be maintained in the SQL Database as per department policies and procedures.
- Conducts Utilization Management reviews for assigned patients, regardless of their insurance, to determine need for treatment and appropriateness of care. Discusses concerns regarding these issues with the attending physician and, if necessary, the treatment team and proactively works to resolve UM issues.