Physician Utilization Review Specialist Per Diem

PHYSICIAN UTILIZATION REVIEW SPECIALIST PER DIEM –
JFK Johnson Rehabilitation Institute

Requisition #:  Shift Day. Status:
Per Diem.

Senior Utilization Review Specialist collaborates with the healthcare team to manage and resolve activities ensuring the integrity of clinical records for the patient population and Hackensack UMC. Responsibilities include utilization review, hospital reimbursement, clinical compliance, case management, and transitions of care.

• Ensure regulatory compliance and provide guidance regarding CMS & NJDOH regulations for Utilization Management and clinical documentation.
• Oversee accurate patient status determinations (Observation vs. Inpatient).
• Liaise with Medical Staff and support Utilization Management Committee processes.
• Manage hospital-based appeals and provide guidance on medical appropriateness and level of care needs.
• Act as liaison between medical staff and clinical staff, communicating effectively and utilizing broad clinical knowledge.
• Serve as physician educator, delivering formal educational lectures and engaging in informal meetings.
• Conduct retrospective record documentation reviews, clarifying ambiguities and evaluating DRG/CC categories.
• Utilize guidelines to assess patient status based on length of stay, level of care, Medicare regulations, MCC/CC.
• Coordinate with third‑party payers when necessary.
• Lead and support utilization management strategies, benchmarking, cost management, and quality improvement initiatives.
• Collaborate with Clinical Delivery and Operations leadership to enhance medical management effectiveness.
• Provide written and verbal reports on utilization management activities.
• Promote a working environment consistent with Hackensack Meridian Health values‑based culture.
• Coordinate revenue cycle clinical protocols and strategies.
• Partner with leadership to achieve strategic objectives through initiatives and denials reduction efforts.
• Support pre‑admission review, utilization management, concurrent and retrospective review processes.
• Review and facilitate level of care determinations (Inpatient, Observation, Outpatient).
• Lead improvement and outcomes studies related to utilization management.
• Collaborate with EHR and CDI teams; assist with technology implementation.
• Perform other duties as assigned.

• Medical degree from a recognized medical school.
• Completion of an accredited residency program.
• Minimum of 3 years of medical practice experience.
• Effective communication skills with peers, department members, and administration.
• Medical Doctor license.
• Maintains at least one medical board certification (preferred).
• At least 2 years of experience in utilization review, including knowledge of regulatory requirements and peer‑to‑peer denial interactions with third‑party payers (preferred).

Minimum hourly rate: $103. The posted rate is an estimate in accordance with the New Jersey Pay Transparency Act and does not reflect the full total rewards package.

Benefits include health, dental, vision, paid leave, tuition reimbursement, and retirement benefits. Shift differentials may apply for evening, night, or weekend work.

HACKENSACK MERIDIAN HEALTH (HMH) IS AN EQUAL OPPORTUNITY EMPLOYER. All qualified applicants will receive consideration for employment without regard to age, race, color, creed, religion, sex, sexual orientation, gender identity or expression, pregnancy, breastfeeding, genetic information, refusal to submit to a genetic test or provide results, atypical hereditary cellular or blood trait, national origin, nationality, ancestry, disability, marital status, military service status, or veteran status.