RN Utilization Review & Care Coordination Specialist

01 The Valley Hospital; 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

Tuition Assistance

Job summary

The Valley Hospital in Paramus, NJ is seeking an Utilization Case Manager to perform concurrent reviews ensuring medical necessity and regulatory compliance. You will collaborate with physicians, payers, and care teams to support admission decisions and optimize length of stay.

Requires BSN and an active New Jersey RN license; experience in case management or utilization review is preferred. Strong communication and EMR skills are essential in a fast-paced environment.

Qualifications

• Bachelor's degree in nursing (BSN) required.
• Current RN license in New Jersey required; case management/UR experience preferred.
• Knowledge of utilization review principles, medical necessity criteria, CMS/payer requirements.

Responsibilities

• Performs concurrent utilization review to ensure appropriate level-of-care determinations and medical necessity.
• Collaborates with physicians, payers, and care coordination staff to support admission decisions and prevent denials.
• Serves as a resource on utilization management, payer requirements, and reimbursement regulations.

Skills

Utilization review

Medical necessity

CMS guidelines

Payer coordination

EMR systems

Clinical reasoning

Education

BSN

RN license

Tools

EMR systems

Job description

The Valley Hospital in Paramus, NJ is seeking an Utilization Case Manager to perform concurrent reviews ensuring medical necessity and regulatory compliance. You will collaborate with physicians, payers, and care teams to support admission decisions and optimize length of stay.

Requires BSN and an active New Jersey RN license; experience in case management or utilization review is preferred. Strong communication and EMR skills are essential in a fast-paced environment.