Clinical Utilization & Denial Manager

Virtua Health; Pennsauken Township (NJ); On-site; USD 52,803 - 82,077; Full time

Benefits offered by this job

Comprehensive medical/prescription insurance

Dental and vision insurance

Paid time off and sick leave

Tuition assistance

Job summary

Virtua Health in Pennsauken Township, NJ, is seeking a Utilization Management professional. The role focuses on maintaining compliance and achieving patient outcomes through appropriate medical necessity tools. Candidates should have a nursing background, preferably with clinical experience and an understanding of managed care.

The position includes managing denials, consulting with physicians, and documenting assessments. A comprehensive benefits package is also offered to both full-time and part-time colleagues.

Qualifications

• 3 years clinical nursing (RN) experience or 3 years as Clinical Social Worker.
• Basic understanding of Medicare, Medicaid, and managed care.
• Discharge planning or home health background.

Responsibilities

• Utilizes payer specific screening tools for determination of medical necessity.
• Consults with Physician Advisor on medical necessity and length of stay.
• Manages concurrent and retroactive denials through communication.

Skills

Excellent verbal and written communication skills

Problem solving

Critical thinking

Conflict resolution

Education

Graduate of an accredited School of Nursing

Job description

Virtua Health in Pennsauken Township, NJ, is seeking a Utilization Management professional. The role focuses on maintaining compliance and achieving patient outcomes through appropriate medical necessity tools. Candidates should have a nursing background, preferably with clinical experience and an understanding of managed care.

The position includes managing denials, consulting with physicians, and documenting assessments. A comprehensive benefits package is also offered to both full-time and part-time colleagues.