Remote Outcomes Manager – Denial & Utilization Expert

Virtua; Pennsauken Township (NJ); On-site; USD 52,348 - 82,656; Part time

Benefits offered by this job

Medical insurance

Paid time off

Sick leave

401(k) with bargaining alignment

Tuition assistance

Employee assistance program

Job summary

Virtua Health in New Jersey seeks a part-time Per Diem RN for Utilization Management and denial management. You will apply medical necessity tools, document reviews, and coordinate with physicians and payers to support compliant patient care and cost effectiveness.

Requirements include 3 years RN experience or 3 years as Clinical Social Worker, NJ RN license, and Case Management certification within one year. Remote work options may apply; competitive hourly rate offered.

Qualifications

• 3 years clinical nursing (RN) experience or 3 years as Clinical Social Worker.
• Basic understanding of Medicare, Medicaid and managed care.
• Discharge planning or home health background.
• Excellent verbal and written communication, problem solving and conflict resolution.

Responsibilities

• Utilization Management: use payer tools to assess level of service and medical necessity.
• Documentation of clinical review and denial management in systems.
• Denial Management: handle concurrent/retrospective appeals with teams and payers.
• Metrics: contribute to dashboards and continuous improvement initiatives.
• Compliance: identify and report compliance issues per federal/state requirements.

Skills

RN experience

UR/CM/QM experience

Clinical Social Worker experience

Education

Graduate of an accredited School of Nursing

Job description

Virtua Health in New Jersey seeks a part-time Per Diem RN for Utilization Management and denial management. You will apply medical necessity tools, document reviews, and coordinate with physicians and payers to support compliant patient care and cost effectiveness.

Requirements include 3 years RN experience or 3 years as Clinical Social Worker, NJ RN license, and Case Management certification within one year. Remote work options may apply; competitive hourly rate offered.