Acute Care RN Utilization Review & Care Coordination

Deborah Heart and Lung Center; Pemberton Township (NJ); On-site; USD 46,000 - 66,000; Full time

Benefits offered by this job

Healthcare coverage

Paid time off

401K matching

Tuition assistance

Disability benefits

Life insurance

Meal discount

Dependent care subsidy

Adoption assistance

Free parking

Job summary

Deborah Heart and Lung Center in New Jersey is seeking a Utilization Review Case Manager to validate patient placement at the most appropriate level of care using InterQual or MCG criteria and to complete initial and continued stay reviews. The UR Case Manager coordinates with payers to secure timely authorizations and ensures documentation aligns with CMS Utilization Review requirements.

You will monitor medical necessity, discharge planning, resource management, and care coordination with

Qualifications

• Graduate of accredited nursing program (diploma/associate/bachelor).
• Knowledge of CMS and payer requirements.
• Experience with discharge planning and resource management.
• Experience with utilization review documentation.

Responsibilities

• Validate patient placement using national admission criteria.
• Collaborate with payers to obtain authorizations.
• Perform initial and continued stay reviews.
• Document utilization review data in EHR and UR systems.
• Work schedule is M-F; weekends/holidays/on-call may be required.

Skills

Nursing experience

Utilization review

Communication skills

Discharge planning

InterQual/MCG criteria

Education

RN licensure in NJ

BSN preferred

Job description

Deborah Heart and Lung Center in New Jersey is seeking a Utilization Review Case Manager to validate patient placement at the most appropriate level of care using InterQual or MCG criteria and to complete initial and continued stay reviews. The UR Case Manager coordinates with payers to secure timely authorizations and ensures documentation aligns with CMS Utilization Review requirements.

You will monitor medical necessity, discharge planning, resource management, and care coordination with