Inpatient Utilization Review RN – Denials & Appeals
Capital Health System, Inc.
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Benefits offered by this job
Job summary
Capital Health is seeking a qualified Utilization Review RN to lead inpatient UR activities, manage denials, and coordinate with HIM and billing to optimize reimbursement. The role requires RN licensure in NJ, 5 years of nursing and 3 years in case management with UR experience.
Strong regulatory knowledge is essential, along with attention to detail and cross‑functional collaboration. The position resides in a hospital system with comprehensive benefits, a structured appeals process, and
Qualifications
- RN license in New Jersey and graduation from an accredited RN program
- Minimum 5 years of nursing experience and 3 years in case management/UR, discharge planning, outcomes management or care coordination
- Experience with inpatient denial appeals is preferred
Responsibilities
- Monitor inpatient utilization process per standards and contracts
- Support denial and appeal processes for the department
- Coordinate with HIM and billing to ensure proper reimbursement
- Maintain accurate utilization audit records and track denial life cycle
- Stay current with CMS/NJDHSS regulations related to managed care
- Enter and update denials in UR software and prepare/submit appeals
Skills
Education
Tools
Job description
Capital Health is seeking a qualified Utilization Review RN to lead inpatient UR activities, manage denials, and coordinate with HIM and billing to optimize reimbursement. The role requires RN licensure in NJ, 5 years of nursing and 3 years in case management with UR experience.
Strong regulatory knowledge is essential, along with attention to detail and cross‑functional collaboration. The position resides in a hospital system with comprehensive benefits, a structured appeals process, and
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