RN Utilization Case Manager, Care Coordination, Full Time, Days

Valley Health System; Paramus (NJ); On-site; Full time

Job summary

Join Valley Health System as a Utilization Review Nurse, where you'll perform critical patient evaluation activities and collaborate with medical professionals to ensure optimal resource utilization and compliance with guidelines. Bring your clinical expertise and strong problem-solving skills to support high-quality patient care in a dynamic healthcare environment.

Benefits

Medical/Prescription, Dental & Vision Discount Program

Group Term Life Insurance and AD&D

Flexible Spending Accounts and Commuter Benefit Plans

Tuition Assistance

Retirement Plan

Employee Assistance Program (EAP)

Day Care Discounts for Various Daycare Facilities

Paid Holidays, Paid Time Off, Wellness Time Off

Membership Discount for Fitness Center

Qualifications

• Must be a Registered Nurse, licensed in New Jersey.
• Minimum 5 years of clinical nursing experience.
• At least 3 years in case management/utilization.

Responsibilities

• Perform concurrent utilization review activities on all patients.
• Collaborate with medical staff on utilization review guidelines.
• Monitor and manage length of stay and resource utilization.

Skills

Critical Thinking

Clinical Reasoning

Problem-Solving

Effective Communication

Education

Bachelor's degree in nursing (BSN)

Job description

POSITION SUMMARY:

Performs concurrent utilization review activities on all patients within the assigned caseload. Collaborates and educates the medical staff on appropriate utilization review guidelines and documentation in accordance with CMS regulations and commercial payor guidelines. Monitors and intervenes on LOS, resource utilization, and denial management/prevention within the assigned caseload.

EDUCATION:

Bachelor's degree (BSN) in nursing required.

EXPERIENCE:

Minimum 5 years’ experience in clinical nursing, with at least 3 years in case management/utilization.

SPECIAL SKILLS:

Registered Nurse, licensed in the State of New Jersey. Current acute care clinical knowledge with a broad-based medical/surgical background. Demonstrates effective interaction and communication skills. Strong critical thinking, clinical reasoning, and problem-solving skills. Ability to perform work accurately with attention to detail, often switching tasks efficiently. Capable of functioning competently in stressful situations and a changing work environment. Ability to work collaboratively within the healthcare system with patients, families, and multidisciplinary team members.

Job Location: The Valley Hospital - Paramus

Shift: Day (United States of America)

Benefits:

• Medical/Prescription, Dental & Vision Discount Program (Full Time/Part Time Employees)
• Group Term Life Insurance and AD&D (Full Time Employees)
• Flexible Spending Accounts and Commuter Benefit Plans
• Supplemental Voluntary Benefits (e.g., Short-term and Long-term Disability, Whole Life Insurance, Legal Support)
• 6 Paid Holidays, Paid Time Off (varies), Wellness Time Off, Extended Illness
• Retirement Plan
• Tuition Assistance
• Employee Assistance Program (EAP)
• Valley Health LifeStyles Fitness Center Membership Discount
• Day Care Discounts for Various Daycare Facilities

Salary: $46.64 - $58.29 per hour. Joining Valley Health System means becoming part of a dedicated team that values high-quality care in a supportive environment. Salaries are commensurate with experience, education, and licensure. This salary range does not include other compensation or benefits.

EEO Statement:

Valley Health System is an equal opportunity employer and does not discriminate based on various protected characteristics as outlined by law, in all employment practices.