The Corporate Utilization Management Auditor RN audits management medical necessity criteria application and evaluate quality of system case management documentation.
Performs monthly MCG and Clinical Review Audits for Managed Care Accounts - The auditor will review 30 charts per month at each hospital or 10% of the volume per month at each hospital (whichever is greater)
Sorts and numbers the patient population for each hospital by Case Manager and Date of Admission. Reviews cases within sample for correct MCG Application: Utilizing MIDAS, Allscripts and Cerner ACM to determine if a MCG review was accurately completed by Case Manager
Prepares summary report of MCG Application and Quality of Clinical Review provides findings and recommendations to Educators
BSN required, Masters preferred
Must have a current, valid New Jersey registered, professional nurse license
Must have expertise in utilization review and case management
Certification in case management preferred
InterQual IQCI, MCG certification, and MCG Train the Trainer program completion required or obtained within six months of employment. InterQual and MCG training will be sponsored by RWJBarnabas Health
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
We offer a great work environment, competitive rates and excellent benefits, including:
Vacation/Personal/Holiday/Sick Time Off
Short & Long Term Disability
Basic Life & Accidental Death Insurance
Health Care/Dependent Care Flexible Spending Accounts
RWJBarnabas Health is the most comprehensive health care delivery system in New Jersey and the state s second largest private employer with more than 32,000 employees, 9,000 physicians and 1,000 residents and interns. The system includes eleven acute care hospitals, three acute care children s hospitals and a leading pediatric rehabilitation hospital (Children s Specialized Hospital).