Inpatient Denials UR RN | Day Shift

Capital Health; Northern (KY); Hybrid; USD 87,000 - 120,000; Full time

Benefits offered by this job

Medical Plan

Prescription drug coverage

Dental Plan

Vision Plan

Flexible Spending Account (FSA)

Retirement Savings and Investment Plan

Life Insurance

Disability Benefits (LTD/STD)

Employee Assistance Program

Commuter Transit

Commuter Parking

Paid Time-Off

Job summary

Capital Health is seeking a Clinical Denials Utilization Review RN for full‑time day shift in Pennington, NJ. The role focuses on utilization review for inpatient cases, denials, and appeals, with collaboration across HIM and billing to ensure appropriate reimbursement.

The candidate will perform audits, prepare written appeals, and support performance improvement initiatives within the department. NJ RN licensure and 5 years' nursing experience are required.

Qualifications

• RN license in NJ and graduation from an accredited nursing program.
• 5 years nursing experience with 3+ years in case management and utilization review.
• Inpatient denial appeals experience preferred.
• Proficient with CMS guidelines and payer contracts.
• Familiar with UR software and EMR systems.

Responsibilities

• Monitor inpatient utilization and ensure UR processes meet standards.
• Support denial and appeal processes for the department.
• Coordinate with HIM and billing to ensure reimbursement.
• Perform chart reviews and utilization audits as directed.
• Maintain records of utilization audits by payors and QIO.
• Enter denials into UR software and track lifecycle.
• Prepare appeals and submit to auditing agencies.

Skills

CMS guidelines

Denial management

Utilization review

Discharge planning

Audit & compliance

Education

RN licensure

Tools

UR software

EMR systems

Word/Excel/Outlook

Job description

Capital Health is seeking a Clinical Denials Utilization Review RN for full‑time day shift in Pennington, NJ. The role focuses on utilization review for inpatient cases, denials, and appeals, with collaboration across HIM and billing to ensure appropriate reimbursement.

The candidate will perform audits, prepare written appeals, and support performance improvement initiatives within the department. NJ RN licensure and 5 years' nursing experience are required.