The Corporate Educator of Utilization Review will serve as a System content expert for InterQual and MCG Criteria for any RWJBarnabas Health employee or contracted employee providing support for Utilization Management Auditor and Case Management Directors.
Maintain expert level competency and certification in InterQual and MCG Criteria sets
Deliver education materials for InterQual and MCG Criteria trainings
Train approximately 350 RWJBarnabas Health employees, contracted vendors, and affiliate staff on InterQual and MCG Acute and Behavioral Health Criteria annually.
Administer Interrater Reliability testing for both InterQual and MCG Criteria to 350 trained staff annually (700 tests total)
Remediate and retest staff who failed to pass the Interrater Reliability test
Provide opportunities for improvement and assist Manager to design ongoing education to raise proficiency of trained staff
Advise Denials and Corporate Appeals department by ensuring content of appeal letters reflects accurate use of medical necessity criteria and educating new hires
Support redesign of care management programs through a focused education and providing operational feedback related to utilization review
Guide/implement expert level nursing documentation to guide physicians in clinical decision making for medical necessity
Work collaboratively with peers to meet scorecard outcomes
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).