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/Dental/Vision (Full Time)

Group Term Life Insurance and AD&D

Flexible Spending Accounts

Voluntary benefits (disability, life,

6 paid holidays and PTO

Retirement Plan

Tuition Assistance

Employee Assistance Program (EAP)

Fitness Center Membership Discount

Day care discounts

Job summary

Valley Health in Paramus, NJ seeks a seasoned Utilization Case Manager to perform concurrent utilization review, ensuring medical necessity and regulatory compliance. You will collaborate with physicians, payers, and care coordination teams to support admission decisions, optimize length of stay, and ensure CMS and payer adherence.

RN license in NJ and BSN are required; prior case management or utilization review experience is strongly preferred.

Qualifications

• BSN required.
• RN license in NJ required.
• Experience in case management or utilization review preferred.

Responsibilities

• Performs concurrent utilization review for medical necessity and regulatory compliance.
• Collaborates with physicians, payers, and care coordination to support admission decisions.
• Promotes compliance with CMS, payer requirements and utilization management best practices.

Skills

Acute care nursing

Utilization review

Communication

Clinical reasoning

EMR proficiency

Collaboration

Education

BSN

Tools

Electronic Medical Records

Case management software

Job description

Valley Health in Paramus, NJ seeks a seasoned Utilization Case Manager to perform concurrent utilization review, ensuring medical necessity and regulatory compliance. You will collaborate with physicians, payers, and care coordination teams to support admission decisions, optimize length of stay, and ensure CMS and payer adherence.

RN license in NJ and BSN are required; prior case management or utilization review experience is strongly preferred.