RN Utilization Reviewer — Case Management & Payer Authorization

Atlantic Health System; Morristown (NJ); On-site; USD 56,000 - 101,000; Full time

Job summary

Atlantic Health System is seeking a Utilization Reviewer (RN) for Morristown, NJ. This full-time, day-shift role supports payer authorizations and discharge planning through proactive reviews and collaboration with the CM team.

The position requires an accredited nursing degree, an active RN license, and experience in case management is preferred. This role is based at Morristown Medical Center with competitive benefits.

Qualifications

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

Responsibilities

• Provides timely and thorough clinical information to insurance companies and other intermediaries to secure payer authorizations and avoid denials or reduction in level of care.
• Performs daily surveillance of observation cases and collaborates with Physician Assistant to address barriers to progression or discharge.
• Intervenes proactively to avoid denials or delays in authorization.
• Communicates progress and payer issues to CM team and interdisciplinary teams regarding hospitalization and discharge planning.
• Refers cases to Physician Advisors or Designees with timely follow up as indicated.
• Assists in identifying and collecting avoidable days.
• Coordinates with CM RN/CMA to complete CMS patient notices.
• Completes and documents utilization reviews, physician advisor referrals and related communications per policy.
• Complies with CMS-required notices and other regulatory requirements within utilization management.

Education

RN license

BSN - preferred

Case Management – Preferred

Job description

Atlantic Health System is seeking a Utilization Reviewer (RN) for Morristown, NJ. This full-time, day-shift role supports payer authorizations and discharge planning through proactive reviews and collaboration with the CM team.

The position requires an accredited nursing degree, an active RN license, and experience in case management is preferred. This role is based at Morristown Medical Center with competitive benefits.