RN Case Manager - Utilization Review On-site at Deborah Heart and Lung Center Browns Mills, NJ

null; Pemberton Township (NJ); On-site; USD 46,222 - 65,831; Full time

Benefits offered by this job

Healthcare coverage

Generous paid time-off

401K matching contribution

Tuition assistance

Short and long term disability

Life insurance

Meal discount

Dependent care subsidy

Adoption assistance

Free parking

Job summary

Deborah Heart and Lung Center in Browns Mills, NJ is seeking an RN Case Manager for Utilization Review on-site. This role focuses on validating patient placement to the most appropriate level of care using criteria such as InterQual or MCG, securing timely authorizations, and guiding care decisions.

Qualified candidates will have 3–5 years of acute care nursing experience, NJ RN licensure, and preferably case management certification.

Qualifications

• RN licensure in NJ required
• BSN preferred
• 3–5 years acute care nursing experience
• Certification in case management preferred
• Graduate of accredited nursing program or diploma/associate/baccalaureate degree

Responsibilities

• Validate patient placement to the most appropriate level of care using admission criteria (e.g., InterQual/MCG).
• Perform initial and continued stay reviews.
• Secure timely authorization for clinical services with payers.
• Comply with UR process per CMS Conditions of Participation.

Skills

Clinical knowledge

Collaboration

Organizational skills

EHR knowledge

Discharge planning

CMS knowledge

Communication skills

Problem solving

Self-directed

Education

Nursing diploma/degree

BSN preferred

Tools

EHR systems

Job description

RN Case Manager – Utilization Review – On-site – Deborah Heart and Lung Center

Browns Mills, NJ.

Job Details

Position Summary: The Utilization Review Case Manager validates the patient’s placement to be at the most appropriate level of care based on nationally accepted admission criteria. The UR Case Manager uses medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient’s expected length of stay. The UR Case Manager secures authorization for the patient’s clinical services through timely collaboration and communication with payers as required. The UR Case Manager follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.

Experience: Required: 3 to 5 years acute care nursing experience. Preferred: Experience in case management.

Education: Required: Graduate of accredited diploma, associate degree or baccalaureate degree nursing program. Preferred: BSN preferred.

License and Credentials: Required: NJ RN licensure. Preferred: Certification in case management.

Required Skills

• Current sound clinical knowledge; knowledge of medical literature, research methodology, financial/ reimbursement issues.
• Strong collaboration, communication and interpersonal skills.
• Excellent organizational and time management skills.
• Knowledge of computers, Electronic Health Records, data base systems and utilization review/case management documentation systems.
• Desire to work collaboratively and proactively with healthcare teams and other hospital-based interdisciplinary teams.
• Current knowledge of discharge planning, resource management, and care coordination in an acute care setting.
• Knowledge of CMS, commercial payer requirements and hospital financial/reimbursement processes.
• Excellent written/verbal communication skills, critical thinking skills, creative problem solving skills, good organizational and planning skills.
• Must be self-directed, have the ability to tolerate frequent interruption and work in a fast-paced work environment.
• Knowledge of funding, resources, services, clinical standards, care coordination processes and outcomes is preferred.

Compensation and Schedule

• Bi-Weekly Hours: 80
• Work Schedule: M - F (Weekends, Holidays, or On Call may be required)
• Minimum starting rate for this position is $40.67

Benefits

• Healthcare coverage for team members in regularly budgeted positions of at least 30 hours per week.
• Generous paid time-off
• 401K matching contribution
• Tuition assistance
• Short and long term disability benefits
• Life insurance
• Meal discount
• Dependent care subsidy
• Adoption assistance
• Free parking

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.