Per Diem Utilization Review RN – Day Shifts

Capital Health Screening Centre; Pennington (NJ); On-site; USD 5,428,000 - 7,164,000; Full time

Benefits offered by this job

Retirement Savings Plan

Disability Benefits – STD

Sick Time Off

Employee Assistance Program

Job summary

Capital Health is seeking a per diem Utilization Management RN to perform chart reviews, admission reviews, and ongoing payer communications. The role focuses on quality, cost-effective care and works with the care team to optimize patient flow and avoid unnecessary stays.

Requirements include an Associate's degree in nursing and NJ RN license; preferred credentials include CPHQ, CCM or CPUR. Expected shifts are mostly day hours with occasional 4-8 PM shifts.

Qualifications

• Associate's degree in nursing; NJ RN license.
• 5 years of clinical nursing experience and 3 years in quality management/utilization review or discharge planning.
• CPHQ, CCM or CPUR preferred.

Responsibilities

• Perform chart reviews to assess quality, timeliness and appropriateness of care.
• Conduct admission reviews for Medicare/Medicaid and private payers based on guidelines.
• Perform concurrent and retrospective reviews with payers per CMS and internal policies.
• Identify strategies to reduce length of stay and optimize resource use.
• Collaborate with care teams to resolve progression of care barriers.

Skills

Quality management

Utilization review

Discharge planning

Nursing

Payer communication

Microsoft Office

EMR

MCG guidelines familiarity

Education

Associate's degree in nursing

Tools

UR software

EMR

Microsoft Office

Job description

Capital Health is seeking a per diem Utilization Management RN to perform chart reviews, admission reviews, and ongoing payer communications. The role focuses on quality, cost-effective care and works with the care team to optimize patient flow and avoid unnecessary stays.

Requirements include an Associate's degree in nursing and NJ RN license; preferred credentials include CPHQ, CCM or CPUR. Expected shifts are mostly day hours with occasional 4-8 PM shifts.