RN - Utilization Management & Care Optimization

Capital Health (US); Pennington (NJ); On-site; USD 54,000 - 71,000; Full time

Benefits offered by this job

Medical Plan

Dental Plan

Vision Plan

Flexible Spending Account

Paid Time Off

Job summary

Capital Health seeks a qualified Utilization Management RN to optimize patient care quality and resource use. You will perform chart reviews, admissions assessments, and payer communications to ensure appropriate levels of care and cost efficiency.

The role requires a NJ-licensed RN with several years in clinical nursing and utilization review, plus familiarity with MCG guidelines and UR software. Strong collaboration with the care team is essential.

Qualifications

• Education: Associate's degree in nursing; RN license in NJ.
• Experience: 5 years nursing and 3 years in quality/utilization or discharge planning.
• Credentials: NJ RN license; CPHQ/CCM/CPUR preferred.

Responsibilities

• Review charts to assure quality and timely patient care.
• Conduct admissions reviews for CMS/Medicare and other payers.
• Collaborate with care team to reduce length of stay and optimize resources.

Skills

Registered Nurse (NJ)

Utilization Review

Quality Management

CMS guidelines

Care Coordination

Education

Associate's degree in nursing

Tools

UR Software

EMR

Microsoft Office

MCG guidelines

Job description

Capital Health seeks a qualified Utilization Management RN to optimize patient care quality and resource use. You will perform chart reviews, admissions assessments, and payer communications to ensure appropriate levels of care and cost efficiency.

The role requires a NJ-licensed RN with several years in clinical nursing and utilization review, plus familiarity with MCG guidelines and UR software. Strong collaboration with the care team is essential.