Strategic RN Utilization Review Specialist

Atlantic Health System; Morristown (NJ); On-site; USD 85,000 - 100,000; Full time

Benefits offered by this job

Total Rewards package

Tuition Assistance

Backup childcare

Well-Being rewards

Job summary

Atlantic Health System in Morristown, NJ is seeking an experienced registered nurse for case management to coordinate patient care, secure payer authorizations, and support timely discharges across inpatient and post-acute services.

The role requires an accredited nursing program graduate with an active RN license; BSN preferred and case management experience is a plus. You will collaborate with physicians, social workers, and payers to optimize care and utilization.

Qualifications

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

Responsibilities

• Provide timely clinical information to payers to secure authorizations and avoid denials.
• Perform daily surveillance of observation cases and coordinate with PA on barriers to progression or discharge.
• Proactively intervene to avoid denials or delays in authorization.
• Communicate progress or payer issues to CM team and interdisciplinary teams.
• Refer cases to Physician Advisors with timely follow up as indicated.
• Identify and collect avoidable days to improve utilization.
• Coordinate CMS patient notices with CM RN/CMA.
• Complete utilization reviews and related communications per policy.
• Comply with CMS-required notices and Utilization Management processes.
• Maintain proficiency in clinical review criteria with IRR testing.

Skills

Communication

Interdisciplinary teamwork

Education

Graduate of accredited nursing program

RN license

BSN preferred

Case Management preferred

Job description

Atlantic Health System in Morristown, NJ is seeking an experienced registered nurse for case management to coordinate patient care, secure payer authorizations, and support timely discharges across inpatient and post-acute services.

The role requires an accredited nursing program graduate with an active RN license; BSN preferred and case management experience is a plus. You will collaborate with physicians, social workers, and payers to optimize care and utilization.