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 Life Insurance & AD&D

Flexible Spending Accounts & Commuter

Tuition Assistance

Retirement Plan

Employee Assistance Program (EAP)

Fitness Center Discount

Day Care Discounts

Job summary

Valley Health System in Paramus, NJ is seeking an Utilization Case Manager to perform concurrent utilization review, ensuring medical necessity and CMS compliance. The role collaborates with physicians, payers, and care coordination staff to support admission decisions and optimize length of stay.

The ideal candidate holds a New Jersey RN license and BSN, with experience in case management or utilization review preferred.

Qualifications

• RN license valid in New Jersey is required.
• BSN in Nursing is required.
• Case management and/or utilization review experience preferred.

Responsibilities

• Perform concurrent utilization review to determine appropriate level of care and medical necessity.
• Collaborate with physicians, payers, Physician Advisors, and care coordination staff to support admission decisions and optimize length of stay.
• Ensure compliance with CMS, payer requirements and reimbursement regulations; promote quality patient outcomes.

Skills

RN license required

Case management

Utilization review

Communication

EMR software

Critical thinking

Multitasking

Education

BSN in Nursing

Tools

EMR systems

Job description

Valley Health System in Paramus, NJ is seeking an Utilization Case Manager to perform concurrent utilization review, ensuring medical necessity and CMS compliance. The role collaborates with physicians, payers, and care coordination staff to support admission decisions and optimize length of stay.

The ideal candidate holds a New Jersey RN license and BSN, with experience in case management or utilization review preferred.