Central Utilization Review Manager — Denials & Appeals

Atlantic Health; Morristown (NJ); On-site; USD 110,000 - 140,000; Full time

Job summary

Atlantic Health is seeking a Manager for Central Utilization Review in Morristown, NJ. The role leads denial prevention initiatives and collaborates with revenue cycle leaders to optimize care levels, documentation, and workflows across hospital sites.

Responsibilities include overseeing appeals with Physician Advisors, coordinating with managed care, and driving data-backed improvements in utilization review. RN leadership and case management experience are essential.

Qualifications

• Graduate of an accredited school of nursing.
• Advanced degree in Business, Nursing and/or Health Care Administration required.
• Leadership experience care and management of acute hospitalized patients.
• Case management training from a professional Case Management organization, preferred.

Responsibilities

• Lead clinical denial prevention and management initiatives to support appropriate level of care.
• Collaborates with Executive Director of Case Management to address barriers and gaps in utilization review and authorization confirmation services.
• Provide oversight for appeals assigned to the Physician Advisor (PA) and potential account downgrades.
• Works with Conifer and Tenet Appeals PA to identify opportunities for improvement including documentation and process.
• Oversees the development and implementation of clinical appeals workflow to incorporate PA review prior to any account downgrade.
• Develops and implements best practices to achieve organizational goals through leading change in a matrix environment.
• Monitors performance and drives improvement through data analytics and cross-functional collaboration.

Education

Graduate of an accredited school of nursing

Advanced degree in Business, Nursing and/or Health Care Administration

Job description

Atlantic Health is seeking a Manager for Central Utilization Review in Morristown, NJ. The role leads denial prevention initiatives and collaborates with revenue cycle leaders to optimize care levels, documentation, and workflows across hospital sites.

Responsibilities include overseeing appeals with Physician Advisors, coordinating with managed care, and driving data-backed improvements in utilization review. RN leadership and case management experience are essential.