RN Utilization Review & Care Coordination Specialist

Valley Health; United States; 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 Commut(

Supplemental Voluntary Benefits

6 Paid Holidays

Paid Time Off

Wellness Time Off

Extended Illness

Retirement Plan

Tuition Assistance

Employee Assistance Program (EAP)

Valley Health LifeStyles Fitness…

Day Care Discounts

Job summary

The Valley Hospital in Paramus, NJ is seeking an experienced Utilization Case Manager to perform concurrent utilization review, ensure medical necessity, and compliance with CMS and payer requirements. You will collaborate with physicians, payers, physician advisors, and care coordination staff to support admission decisions, optimize length of stay, and promote high-quality patient outcomes.

This role requires a BSN and current RN license in New Jersey, with preferred experience in case

Qualifications

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

Responsibilities

• Perform concurrent utilization review to ensure appropriate level-of-care determinations and medical necessity while ensuring regulatory compliance.
• Collaborate with physicians, payers, Physician Advisors and care coordination staff to support admission decisions, prevent denials and optimize length of stay.
• Promote quality patient outcomes and compliance with CMS and payer requirements as a resource on utilization management.

Skills

Communication

Collaboration

Critical thinking

Analytical skills

Multitasking

Education

BSN

Tools

EMR

Case management software

Job description

The Valley Hospital in Paramus, NJ is seeking an experienced Utilization Case Manager to perform concurrent utilization review, ensure medical necessity, and compliance with CMS and payer requirements. You will collaborate with physicians, payers, physician advisors, and care coordination staff to support admission decisions, optimize length of stay, and promote high-quality patient outcomes.

This role requires a BSN and current RN license in New Jersey, with preferred experience in case