Inpatient Denials & Utilization Supervisor

Capital-Health; Trenton (NJ); On-site; USD 94,000 - 123,000; Full time

Benefits offered by this job

Medical Plan

Dental Plan

Vision Plan

Flexible Spending Account (FSA)

Retirement Savings Plan

Life Insurance

Disability Benefits

Paid Time Off

Employee Assistance Program

Job summary

Capital Health is seeking an Utilization Denials Supervisor to lead inpatient concurrent denial operations and audit activities. You will supervise staff, coordinate with clinical teams and payers to ensure timely, accurate denials responses and optimal reimbursement.

The role requires RN background, substantial experience in utilization review, and a focus on quality outcomes. The position emphasizes cross‑functional collaboration, adherence to regulations, and ongoing performance improvement.

Qualifications

• Bachelor of Science in Nursing (BSN) or a related healthcare degree.
• Five years of nursing experience and three years in case management, including utilization review and discharge planning.
• Inpatient denial appeal experience required.

Responsibilities

• Oversee the end-to-end inpatient concurrent denial lifecycle for the department.
• Audit denied encounters throughout the appeals lifecycle to ensure timely responses and revenue recovery.
• Lead staff, coordinate with Patient Access, HIM and Revenue Integrity to secure reimbursement.
• Monitor turnaround times and drive performance toward goals.
• Provide training, mentoring and onboarding for denials staff and perform annual appraisals.
• Maintain knowledge of CMS/NJ regulations and external utilization audits.

Skills

Nursing leadership

Case management

Utilization review

Inpatient denial management

CMS regulations

Education

BSN

Bachelor’s degree in related healthcare field

Tools

InterQual

MCG

EMR software

Microsoft Office

Job description

Capital Health is seeking an Utilization Denials Supervisor to lead inpatient concurrent denial operations and audit activities. You will supervise staff, coordinate with clinical teams and payers to ensure timely, accurate denials responses and optimal reimbursement.

The role requires RN background, substantial experience in utilization review, and a focus on quality outcomes. The position emphasizes cross‑functional collaboration, adherence to regulations, and ongoing performance improvement.