| The utilization review specialist is an RN who collaborates with the case management team and appropriate departments to ensure regulatory compliance pertaining to the denial/appeal process with a focus on obtaining optimal reimbursement for SBMC. The utilization review nurse works collaboratively with key stakeholders such as, physicians, SBO, Executive Health Resources, Med Assets particularly to reconcile patient status type and level of reimbursement. In addition, the utilization review nurse will assist the Manager of Denials to provide education to physicians, case management, department heads, etc regarding denial trends with root causes. Additional responsibilities include: Review one day stay cases Bill holds Medicaid cases 121/131 cases Audits as necessary Assist the Manager of Denials with action plans, process improvement and address gaps and opportunities for improvement. Employees of Saint Barnabas Medical Center are committed to exemplifying the Standards of - Exceptional Communication, Compassionate Care, Outstanding Teamwork, Professional Integrity and Ownership & Accountability - creating an environment of C ompassionate C are, H ealthcare E xcellence and S uperior S ervice (CCHESS) for all that enter our facility. If you share the commitment, dedication and drive meet the CCHESS challenge, we welcome your application. Since 1865, Saint Barnabas Medical Center (SBMC), located at 94 Old Short Hills Road in Livingston, is New Jersey's oldest nonprofit, nonsectarian hospital. The 597-bed institution is one of the largest health care providers in the state, treating more than 35,500 inpatients and over 84,000 Emergency Department patients each year. The Medical Center and the Saint Barnabas Ambulatory Care Center provide treatment and services for more than 300,000 outpatient visits annually. The Medical Staff is comprised of more than 1,600 physicians in 100 medical and surgical specialties and there are over 3,400 employees. As a teaching institution, we have nine residency programs and one fellowship in Mammography and a shared Nephrology fellowship with Newark Beth Israel. There are a total of 154 residents and fellows. Organize and administers individualized age specific professional care to patients in the Cardiac Catheterization Lab. Among Saint Barnabas' nationally recognized facilities are The Burn Center, the only certified burn treatment facility in the state; the Barnabas Health Care System Renal and Pancreas Transplant Division, one of the most active transplant programs in the country; The Saint Barnabas Heart Centers, a world-class cardiac surgery program in affiliation with Newark Beth Israel Medical Center; The Neurology and Neurosurgery Program which is the only program in New Jersey to be ranked by US News and World Report as a Top Hospital for Neurology and Neurosurgery. It is led by an unprecedented team of experts dedicated to diagnosing and treating disorders of the brain and nervous system; the Regional Perinatal Center, providing care for high-risk and critically ill infants in New Jersey's leading Level III, a 56-bed Neonatal Intensive Care Unit; comprehensive Pediatric Services including a dedicated intensive care unit; The Bariatric Surgery Center of Excellence, designated by the American Society of Bariatric Surgery; a nationally accredited Chest Pain Center, The Center for Sleep Disorders; The Comprehensive Stroke Center at Saint Barnabas; extensive services in robotic and minimally-invasive surgery, The Institute for Reproductive Medicine and Science at Saint Barnabas, the widely recognized assisted reproductive technology program; and comprehensive cancer programs and services that includes one of the largest Radiation Oncology programs in northern New Jersey and a highly-specialized Gastrointestinal Cancer Center of Excellence. |
