Utilization Review Manager — Denials Prevention & Improvement

Atlantic Health System; Morristown (NJ); On-site; USD 84,000 - 148,000; Full time

Benefits offered by this job

Tuition Assistance

Backup and On-Site Childcare

Employee Assistance Program (EAP)

Job summary

Atlantic Health System in Morristown, NJ, seeks a Manager of Central Utilization Review to lead denial prevention, utilization review initiatives, and performance improvement across AHS hospitals. You will analyze denials data, collaborate with revenue cycle leaders, and drive corrective actions to meet organizational targets.

The role requires nursing leadership with an advanced degree in health administration and experience in case management, with oversight of appeals and PA workflows.

Qualifications

• Graduate of an accredited school of nursing.
• Advanced degree in Business, Nursing and/or Health Care Administration required.

Responsibilities

• Lead clinical denial prevention and management initiatives to support appropriate level of care.
• Lead denials prevention and performance improvement for AHS hospitals.
• Provide hospitals with performance data analytics to drive improvement.
• Collaborate with Managed Care Contracting to address payer and IRO issues and input to contract language.
• Oversee appeals workflow and PA review to address opportunities for improvement.
• Develop and implement best practices to achieve organizational goals in a matrix environment.
• Manage multi-disciplinary process improvement with strong communication and leadership.
• Educate on regulatory and clinical changes impacting inpatient and post-acute care processes and reimbursement.

Skills

Leadership

Case management

Healthcare analytics

Nursing leadership

Education

Graduate of an accredited school of nursing

Advanced degree in Business, Nursing and/or Health Care Administration

Job description

Atlantic Health System in Morristown, NJ, seeks a Manager of Central Utilization Review to lead denial prevention, utilization review initiatives, and performance improvement across AHS hospitals. You will analyze denials data, collaborate with revenue cycle leaders, and drive corrective actions to meet organizational targets.

The role requires nursing leadership with an advanced degree in health administration and experience in case management, with oversight of appeals and PA workflows.