RN Utilization Reviewer - Case Management (Days)

Atlantic Health; Morristown (NJ); On-site; USD 119,745,000 - 210,780,000; Full time

Job summary

Atlantic Health is seeking an Utilization Reviewer (RN) for the Emergency Department at Overlook Medical Center in Morristown, NJ. This full-time day position supports payer authorizations, monitors observation cases, and collaborates with the CM team to optimize patient progression and discharge planning.

Qualified candidates are graduates of an accredited nursing program with an active RN license. BSN is preferred, and case management experience is a plus for this role within a leading

Qualifications

• Graduate of an accredited school of nursing - required.
• BSN - preferred.
• Current RN license - required.
• Case Management - Preferred.

Responsibilities

• Provides timely clinical information to payers to secure authorizations and prevent denials.
• Performs daily surveillance of observation cases and coordinates with Physician Assistant for progression of care or discharge.
• Intervenes to avoid denials or delays in authorization.
• Communicates progress and payer issues to CM team and interdisciplinary teams.
• Refer cases to Physician Advisors with timely follow up per department procedures.
• Assist in identifying and collecting avoidable days and CMS required notices.
• Complete and document utilization reviews and related communications per policy.
• Comply with CMS and Code 44 regulatory requirements within the utilization management process.

Skills

Nursing

Case Management familiarity

Education

BSN (preferred)

Accredited nursing program

Job description

Atlantic Health is seeking an Utilization Reviewer (RN) for the Emergency Department at Overlook Medical Center in Morristown, NJ. This full-time day position supports payer authorizations, monitors observation cases, and collaborates with the CM team to optimize patient progression and discharge planning.

Qualified candidates are graduates of an accredited nursing program with an active RN license. BSN is preferred, and case management experience is a plus for this role within a leading