Faculty / Staff Resources

Rutgers New Jersey Medical School

Faculty Practice


Clinical Affairs - Office of Managed Care

 

Welcome to the site for the Office of Managed Care. This site will provide Rutgers New Jersey Medical School (NJMS) faculty and staff the tools to answer general questions related to managed care operations and provider contracts. Here you will find information related to credentialing, referrals, and provider agreements. If your questions or concerns are not answered here, please refer to the For More Information section to contact the Office of Managed Care.

 

Who Should Use This Site?

This site is designed as a tool for faculty and staff seeking information related to physician credentialing, precertification, preauthorization, and referral information. You may also access limited information regarding billing, claims, provider agreements, and managed care contracts.

 

Disclaimer

Please note: This site is a tool designed to provide general information only. For detailed or specific information, please contact the member's health plan, utilization management, or the Rutgers NJMS Faculty Practice Clinical Affairs-Office of Managed Care.


Announcements!

Orientation Week 2017

Managed Care Organizations

Group & Individual Health Plans

Click the link for a list of health plans.

To visit an insurance web site directly, click the name of the specific health plan.

Managed Care Organization Contact List

Click the link for a list of contact information for select health plans.

 

 

Referral, Precertification, and Preauthorization Requirements

By Managed Care Organization

Click the link to review referral, precertification, and preauthorization requirements listed by insurance.

 

Additional Resources

Participating Laboratory Locations

Click the link to locate a participating LabCorp or Quest Diagnostics laboratory in New Jersey.

CMS Meaningful Use Calculator

This online tool allows providers to test whether or not they would successfully demonstrate meaningful use for the EHR (Electronic Health Record) Incentive Programs. Click here to visit the Medicare and Medicaid EHR Incentive Program website for more detailed information about the program, including who is eligible to participate (CMS.gov).

My Portal-Rutgers Web Portal

Click the link to connect to the Rutgers Legacy UMDNJ login page. Access web-based resources such as email and important employee information.

 

For More Information

Contact Us:

Rutgers New Jersey Medical School
Clinical Affairs-Office of Managed Care
30 Bergen Street, Admin Complex Bldg 1 Rm 111
Newark, New Jersey 07107

General Tel: 973-972-4908
General Email: NJMSPhysicians@njms.rutgers.edu

  Role Responsibilities Phone/ Fax/ Email
Justin Sambol, MD, FACS

 

Senior Associate Dean for Clinical Affairs
  • Oversees Office of Managed Care and Credentialing
  • Negotiates and Manages Contractual Relationships with Insurers
  • Rutgers Member of Negotiating Committee

P: 973-972-1818
F: 973-972-5413

Email:
sambol@njms.rutgers.edu

Questions regarding contracting should be directed to:
Toni Allen allento@njms.rutgers.edu

Esteban Santana, III M.Div. Manager, Managed Care Operations

P: 973-972-6784
F: 973-972-6804

Email:
santanes@njms.rutgers.edu

Kimberly Pasley Management Assistant
  • Assistant to Department

P: 973-972-4908
F: 973-972-1635

Email:
kimberly.pasley@rutgers.edu

Maria Colón Credentialing Specialist
  • Departments:
    • Family Medicine
    • Medicine
    • OB/GYN
    • Pediatrics
    • Physical Medicine & Rehab (PM&R)

P: 973-972-1813
F: 973-972-6804

Email:
colonm2@njms.rutgers.edu

Jamilah A. Muhammad, BS-HSM Program Support Specialist
  • Credentialing Departments:
    • Ophthalmology
    • Podiatry
    • Psychiatry
  • Web Content Manager for NJMS Patient Care and NJMS Managed Care Websites
  • Web Portal Security Administrator
    • NaviNet
    • Availity
    • United HealthCare Online
  • Health Plan Orientation Coordinator
  • Special Projects

P: 973-972-4843
F: 973-972-6804

Email:
jamilah.muhammad@rutgers.edu

Mr. Kerry D. Strothers Managed Care Coordinator (Credentialing)
  • Departments:
    • Anesthesiology
    • Emergency Medicine
    • Neurology
    • Neurosurgery
    • Orthopedics
    • Otolaryngology (ENT) including Head & Neck Surgery
    • Pathology
    • Radiation Oncology
    • Radiology
    • Surgery

P: 973-972-1814
F: 973-972-6804

Email:
strothke@njms.rutgers.edu

If you have questions or comments about the Rutgers New Jersey Medical School Managed Care website, or wish to report a problem, please contact jamilah.muhammad@rutgers.edu.