RN Utilization Review & Care Coordination Specialist

Valley Health System (New Jersey); Paramus (NJ); Presencial; USD 69.000 - 86.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical benefits

Dental & Vision Discount Program

Group Term Life Insurance and AD&D

Flexible Spending Accounts

Descripción de la vacante

Valley Health System (New Jersey) seeks an Utilization Case Manager to perform concurrent utilization reviews ensuring medical necessity and compliance with CMS and payer requirements. You will collaborate with physicians, payers, and care teams to support admission decisions and optimize length of stay.

Requirements include a BSN in nursing and an active New Jersey RN license, with strong experience in utilization review. The role offers comprehensive benefits and a competitive hourly salary.

Formación

• Bachelor’s degree (BSN) in nursing is required.
• Current RN license in New Jersey is required.
• Experience in case management or utilization review is strongly preferred.

Responsabilidades

• Conduct concurrent utilization reviews to determine appropriate level of care and medical necessity.
• Collaborate with physicians, payers, physician advisors, and care coordination staff to support admission status decisions.
• Ensure compliance with CMS, payer requirements and documentation standards.
• Promote quality patient outcomes and efficient resource utilization while maintaining professional conduct.

Conocimientos

Utilization review

Medical necessity criteria

Clinical reasoning

Communication

Interdisciplinary collaboration

EMR proficiency

Educación

BSN in Nursing

Herramientas

EMR systems

Case management software

Descripción del empleo

Valley Health System (New Jersey) seeks an Utilization Case Manager to perform concurrent utilization reviews ensuring medical necessity and compliance with CMS and payer requirements. You will collaborate with physicians, payers, and care teams to support admission decisions and optimize length of stay.

Requirements include a BSN in nursing and an active New Jersey RN license, with strong experience in utilization review. The role offers comprehensive benefits and a competitive hourly salary.