Utilization Management RN - Improve Care & Efficiency

Capital Health (US)

Trenton (NJ)

On-site

USD 53,726 - 71,635

Full time

14 days+

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Benefits offered by this job

Medical Plan

Prescription drug coverage & In-House

Dental Plan

Vision Plan

FSA

Health Savings

Retirement Savings Plan

Life Insurance

AD&D

Disability Benefits

Employee Assistance Program

Commuter Transit

Commuter Parking

Paid Time-Off Program

Job summary

Capital Health is seeking an experienced Utilization Management RN to review charts, perform admissions reviews, and collaborate with care teams to promote high-quality, cost-effective patient care.

The role requires 5 years of nursing and 3 years in quality management, with NJ RN licensure and proficiency in UR software and EMR. Working hours are typically 8 per day, and the employer offers a comprehensive benefits package.

Qualifications

Associate's degree in nursing from an accredited program.
Five years of clinical nursing experience and three years in quality management, utilization review, or discharge planning.
RN license in NJ (Registered Nurse).

Responsibilities

Perform chart reviews to assess quality, timeliness, and appropriateness of care.
Conduct admission reviews for Medicare/Medicaid and other payers.
Collaborate with care team to optimize length of stay and resource use.
Support compliance with CMS guidelines for utilization reviews.

Skills

Clinical nursing experience

Quality management

Discharge planning experience

Payer communications

Education

Associate's degree in nursing

Tools

UR software

EMR

Microsoft Office

Job description

Capital Health is seeking an experienced Utilization Management RN to review charts, perform admissions reviews, and collaborate with care teams to promote high-quality, cost-effective patient care.

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