Nurse Leader: Central Utilization Review Manager

Atlantic Health; Morristown (NJ); On-site; USD 84,000 - 149,000; Full time

Job summary

Atlantic Health in Morristown, NJ is seeking a Registered Nurse-UR Manager to lead the Central UR nurses and Insurance Specialists. You will oversee assignments, monitor workflow priorities, and ensure timely initial and continued-stay reviews and authorization follow-up.

You will partner with physician advisors and care teams on level-of-care questions, perform data analysis to identify trends, and drive performance improvements across AHS hospitals.

Qualifications

• RN license in the applicable state.
• BSN required.
• Advanced degree in business or health care administration preferred.
• Leadership experience in an acute care setting.
• Experience in acute care case management or utilization review.
• Strong clinical judgment, communication, data analysis, and team leadership skills.

Responsibilities

• Lead, coach, and support the Central UR nurses and Insurance Specialists; manage assignments, workflow priorities, and staff performance.
• Ensure timely initial and continued-stay reviews, authorization follow-up, payer communication, and escalation of cases at risk for denial.
• Partner with physician advisors and care teams on level-of-care questions, peer-to-peer reviews, potential account downgrades, and clinical appeals.
• Analyze denial, appeal, authorization, and UR performance data to identify trends and lead corrective action.
• Work with hospital case management, medical, nursing, and revenue cycle leaders to resolve barriers and improve care progression.
• Identify recurring payer and Independent Review Organization issues and share findings with Managed Care Contracting and appeals leadership.
• Develop clear workflows, education, and tools in response to performance gaps, payer requirements, and regulatory changes.
• Monitor improvement plans and help teams sustain results across AHS hospitals.

Skills

Nursing leadership

Data analysis

Communication

Team leadership

Clinical judgment

Education

BSN

Advanced degree in business or health care administration (preferred)

Job description

Atlantic Health in Morristown, NJ is seeking a Registered Nurse-UR Manager to lead the Central UR nurses and Insurance Specialists. You will oversee assignments, monitor workflow priorities, and ensure timely initial and continued-stay reviews and authorization follow-up.

You will partner with physician advisors and care teams on level-of-care questions, perform data analysis to identify trends, and drive performance improvements across AHS hospitals.