RN Utilization Review & Care Coordination Specialist

Valley Medical Services Inc; Paramus (NJ); On-site; USD 69,000 - 86,000; Full time

Benefits offered by this job

Medical, Dental & Vision Discount (FT/

Group Term Life Insurance & AD&D (FT)

Flexible Spending Accounts

Commuter Benefit Plans

Paid Holidays & PTO

Retirement Plan

Tuition Assistance

Employee Assistance Program (EAP)

Wellness Center Membership Discount

Day Care Discounts

Job summary

The Valley Hospital-Paramus is seeking an Utilization Case Manager to perform concurrent utilization review, ensuring appropriate level-of-care determinations and regulatory compliance. You will collaborate with physicians, payers, and care coordination staff to support admission decisions and optimize length of stay.

Requirements include a BSN and an active NJ RN license; prior utilization review or case management experience is preferred.

Qualifications

• Bachelor's degree in nursing required.
• Current RN license in New Jersey required.
• Experience in case management and/or utilization review preferred.
• Knowledge of CMS, Medicare, Medicaid, and payer requirements.
• Strong communication and collaboration with physicians, payers, patients, families.
• Proficient in the use of electronic medical records and case management software.

Responsibilities

• Perform concurrent utilization review to ensure medical necessity.
• Collaborate with physicians, payers, and care teams to support admission decisions.
• Promote quality patient outcomes and regulatory compliance.
• Serve as resource on utilization management and reimbursement regulations.

Skills

Acute care nursing

Utilization review

CMS/ payer requirements

Physician collaboration

EMR systems

Case management software

Education

BSN in Nursing

Tools

EMR

Case management software

Job description

The Valley Hospital-Paramus is seeking an Utilization Case Manager to perform concurrent utilization review, ensuring appropriate level-of-care determinations and regulatory compliance. You will collaborate with physicians, payers, and care coordination staff to support admission decisions and optimize length of stay.

Requirements include a BSN and an active NJ RN license; prior utilization review or case management experience is preferred.