RN Utilization Review & Care Coordination Specialist

Valley Health System; Paramus (NJ); On-site; USD 69,000 - 86,000; Full time

Benefits offered by this job

Medical/Prescription, Dental & Vision

Group Term Life Insurance and AD&D

Flexible Spending Accounts and Commuty

Tuition Assistance

Retirement Plan

Employee Assistance Program (EAP)

Fitness Center Membership Discount

Daycare Discounts

Job summary

The Valley Hospital-Paramus seeks an Utilization Case Manager to oversee concurrent utilization review, ensuring medical necessity and regulatory compliance. You will collaborate with physicians, payers, and care teams to support admission decisions, prevent denials, and optimize length of stay.

Required is a RN license in New Jersey and a BSN in nursing, with preferred experience in case management or utilization review and proficiency with EMR and case management software.

Qualifications

• RN license in New Jersey is required.
• BSN in nursing required.
• Experience in case management or utilization review preferred.

Responsibilities

• Performs concurrent utilization review to ensure appropriate level-of-care determinations.
• Collaborates with physicians, payers, Physician Advisors, and care coordination staff on admission decisions.
• Supports payment determinations, prevents denials, and optimizes length of stay.
• Ensures compliance with CMS and payer requirements and medical necessity criteria.

Skills

Utilization review

Collaboration

Clinical reasoning

Communication

Education

BSN in nursing

Tools

EMR systems

Case management software

Job description

The Valley Hospital-Paramus seeks an Utilization Case Manager to oversee concurrent utilization review, ensuring medical necessity and regulatory compliance. You will collaborate with physicians, payers, and care teams to support admission decisions, prevent denials, and optimize length of stay.

Required is a RN license in New Jersey and a BSN in nursing, with preferred experience in case management or utilization review and proficiency with EMR and case management software.