RN Outcomes & Denials Manager (Remote)

Virtua; United States; Remote; USD 80,000 - 124,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

Flexible spending accounts

403(b)/401(k)

Paid time off and paid sick leave

Disability and life insurance

Tuition assistance

Employee assistance program

Job summary

Virtua Health is seeking a remote RN to support the application of medical necessity tools, ensuring compliance and achieving positive patient outcomes. You will collaborate with Physician Advisors, manage denials, and document review activities across case management and billing systems.

The role requires 3 years of RN experience, NJ licensure, and prefers a BSN. This full-time, remote position offers benefits and a path to professional growth within a premier health system.

Qualifications

• RN licensure in New Jersey required.
• 3 years RN clinical nursing experience; 1 year UR/CM/QM preferred.

Responsibilities

• Utilizes payer-specific screening tools to determine level of service and medical necessity.
• Consults with Physician Advisor on medical necessity, length of stay, and care appropriateness.
• Identify and manage denials with attending physicians, case management, and payers.
• Document clinical review and denial management in case management and billing systems.
• Support audits using screening tools and proper documentation.
• Contribute to organizational goals and dashboards for success.
• Participate in improvement activities (Six Sigma, teams, community).
• Identify and report compliance issues as appropriate.

Skills

Communication skills

Problem solving

Critical thinking

Conflict resolution

Education

RN license

BSN strongly preferred

Job description

Virtua Health is seeking a remote RN to support the application of medical necessity tools, ensuring compliance and achieving positive patient outcomes. You will collaborate with Physician Advisors, manage denials, and document review activities across case management and billing systems.

The role requires 3 years of RN experience, NJ licensure, and prefers a BSN. This full-time, remote position offers benefits and a path to professional growth within a premier health system.