Description
Utilization Review Physician
Hackensack Meridian Health
Hackensack University Medical Center
Hackensack, New Jersey
Hackensack Meridian Health is seeking a Full Time (full position/ hybrid: 2 days in person and 3 days remote) Utilization Review Physician to join the team at Hackensack University Medical Center. This vital role supports the accuracy and integrity of clinical documentation, regulatory compliance, and effective utilization management across the organization. The ideal candidate will bring strong clinical judgment, leadership, and communication skills to promote excellence in patient care and operational efficiency.
Key Responsibilities:
- Oversee compliance with CMS and NJDOH regulations related to Utilization Management and clinical documentation.
- Ensure accurate patient status determinations (Observation vs. Inpatient) and provide direction on medical appropriateness and level of care needs.
- Serve as a liaison between medical and clinical staff, supporting the Utilization Management Committee and fostering collaboration across departments.
- Provide education and guidance to physicians through lectures, documentation reviews, and case discussions, focusing on clinical documentation improvement and DRG accuracy.
- Support hospital reimbursement and appeals management, including concurrent and retrospective reviews, peer-to-peer interactions, and root cause analyses to minimize denials.
- Partner with case management, clinical operations, and revenue cycle teams to develop and implement Utilization Management strategies that ensure appropriate care in the right setting.
- Utilize UM tools and guidelines (e.g., MCG, Xsolis) to evaluate patient status, length of stay, and medical necessity in alignment with regulatory standards.
- Participate in continuous improvement initiatives, technology integration, and data-driven decision-making to enhance overall utilization performance and patient outcomes.
Qualifications:
- MD or DO from an accredited medical school with completion of a residency program.
- Minimum 3 years of clinical practice experience; prior experience in Utilization Review or Case Management highly preferred.
- Active medical license in good standing; board certification preferred.
- Strong understanding of regulatory requirements, hospital operations, and payer interactions.
- Excellent communication, analytical, and problem-solving skills with a collaborative approach.
Join Hackensack Meridian Health — a nationally recognized leader in academic medicine — and contribute to advancing quality, compliance, and efficiency in patient care.
HOW TO APPLY:
For immediate consideration please contact:
Physician and Advanced Provider Recruiter:
Name: Jodi Fendrick, BSBM-HR, SHRM-CP, CPRP
Email: jodi.fendrick@hmhn.org
Phone: 848-231-1065
Assistant Physician Recruiter:
Name: Helayna Kelly
Email: helayna.kelly@hmhn.org
Phone: 908-839-5693
COMPENSATION:
Minimum Starting Base Salary: $214,240
HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package.
The starting base salary is provided for informational purposes only and is not a guarantee of a specific offer. The base compensation determined at the time of the offer may be different than the posted base salary based on a number of non-discriminatory factors, including but not limited to:
Specialization: Area of specialization and sub-specialization.
Labor Market Data: Compensation is benchmarked against market data to ensure competitiveness.
Experience: Years of relevant experience in the areas of specialization and sub-specialization.
Leadership: Relevant experience as a department chair or chief, practice group leader, or other leadership roles.
Education and Certifications: Degrees attained, residencies, fellowships, board certifications, research, and publications.
Productivity: Levels of productivity, quality and patient satisfaction.
Skills: Demonstrated proficiency in relevant skills and competencies.
Geographic Location: Cost of living and market rates for the specific location.
Internal Equity: Compensation is determined in a manner consistent with compensation ranges for similar roles within the specialty and/or sub-specialty.
Budget and Grant Funding: Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered.
In addition to our compensation for full-time and part-time (20+ hours/week) positions, HMH offers a comprehensive benefits package, including health, dental, vision, tuition reimbursement, and retirement benefits. The final compensation and benefits package will be discussed during the interview process.
