The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical records for the patient population and Hackensack UMC. These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and transitions of care, as outlined in the responsibilities below.

Education, Knowledge, Skills and Abilities Required:

1. Medical degree from a recognized Medical School.

2. Completion of a residency program from an accredited medical institution.

3. Minimum of 3 years medical practice experience.

4. Ability to effectively communicate with professional peers, department members and all levels

of administration.

Education, Knowledge, Skills and Abilities Preferred:

Licenses and Certifications Required:

1. Medical Doctor License.

Licenses and Certifications Preferred:

1. Maintains at least one Medical Board Certification.

2. At least two years experience in Utilization Review processes including knowledge of

regulatory requirements relative to performing status determinations and Peer to Peer denial

interactions with medical directors of third-party payers.

Contacts:

Regular contact with Medical Center personnel, patients and visitors.