Nurse Registered Utilization Management

St. Joseph's Health; Woodland Park (NJ); On-site; USD 85,000 - 115,000; Full time

Benefits offered by this job

Competitive salary

Health, dental, vision plans

403b retirement with match

PTO and holidays

Tuition reimbursement

Employee Assistance Program

Long-term disability

Life Insurance

Onsite daycare

Per diem options

Job summary

St. Joseph’s Health in New Jersey seeks a Utilization Management Registered Nurse (UM RN) to evaluate medical necessity, appropriateness, and efficiency of inpatient and continued care according to criteria and payer requirements.

The role ensures documentation supports care and secures required authorizations while promoting quality outcomes and resource optimization. Qualified candidates will hold a Bachelor of Science in Nursing, an active New Jersey RN license, and 3+ years of nursing

Qualifications

• BSN required or higher
• RN license valid in New Jersey
• 3+ years of nursing experience; preference for review/case management

Skills

Nursing experience

Case management

Licensed RN

Education

Bachelor of Science in Nursing

CCM certification

Job description

Job Description

The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria, regulatory requirements, and organizational role. The UM RN ensures optimal patient care delivery while supporting compliance, quality outcomes, and effective resource utilization. The role is responsible for the assessment of medcial necessity, both for admission to the hospital as well as continued stay. This function ensurses that services are not only appropriate but ensures that an authorization is obtained from the payer, if required, and that the documentation supports the care delivered in such a way that minimzes risks of denials.

Job Description

The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria, regulatory requirements, and organizational role. The UM RN ensures optimal patient care delivery while supporting compliance, quality outcomes, and effective resource utilization. The role is responsible for the assessment of medcial necessity, both for admission to the hospital as well as continued stay. This function ensurses that services are not only appropriate but ensures that an authorization is obtained from the payer, if required, and that the documentation supports the care delivered in such a way that minimzes risks of denials.

Qualifications

Work requires the knowledge of theories, principles, and concepts normally acquired through completion of a Bachelor of Science in Nursing and least at least 3 years of previous nursing experience. Preferred 3+ years of Review or Case Management experience. Case Management Society of America Certification CCM preferred. Licensure required as a Registered Nurse by the State of New Jersey.

About Us

St. Joseph’s Health is recognized for the expertise and compassion of its highly skilled and responsive staff. The combined efforts of the organization’s outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation’s “100 Best Places to Work in Health Care”.

Benefits Eligibility: (Full-time and Part-time Employees-over 20 hours a week)

• Competitive salary*
• Robust benefits with health, dental, Rx and vision plans
• 403b retirement plan options with company match**
• Health & Wellness*
• Non-Profit Health System – eligible for Federal Student Loan Forgiveness
• PTO, and paid holidays
• Tuition reimbursement
• Employee Assistance Program
• LTD : Long Term Disability
• Life Insurance Options
• Onsite Day care Program
• Available for Per Diem Employees and Part-time Employees working under 20 hours per week.
• 403b Company Match not applicable for Per Diem Employees and Part-time Employees working under 20 hours per week.

Pay transparency:

St. Joseph’s Health provides a salary range to comply with New Jersey Law. The rate of pay for each position will be determined based on a variety of factors including the candidate's relevant experience, qualifications, skills, etc.” The salary range does not include incentives, differential pay or other forms of compensation.

About The Team

St. Joseph’s University Medical Center is an academic tertiary care medical center and state designated trauma center, located on the Paterson campus, regularly accepts referrals of difficult or unusual cases from other hospitals and physicians and performs both complex and routine procedures.

The Medical Center offers a full complement of specialty and subspecialty services including ambulatory, behavioral health, cardiovascular, emergency/trauma, internal medicine, neuroscience, oncology, orthopedic/spine, rehabilitation, surgical specialty, women’s health, imaging and pediatrics.

The nursing team at St. Joseph’s University Medical Center, which includes St. Joseph’s Children’s Hospital, has held the Magnet Award for Nursing Excellence, the profession’s highest honor, since 1999. They are also recipients of the prestigious 2010 Magnet Prize™ - one of only 8 Magnet-designated hospitals to ever receive The Magnet Prize, and the only one worldwide to receive the 2010 award.