Utilization Review Manager - RN Lead, Quality & Outcomes

Capital Health (US); Trenton (NJ); On-site; USD 97,947 - 127,982; Full time

Benefits offered by this job

Medical Plan

Dental Plan

Vision Plan

FSA

Retirement Savings and Investment Plan

Life Insurance

Disability Benefits

Commuter Parking

Paid Time-Off

Job summary

Capital Health in New Jersey is seeking an experienced Utilization Review leader to promote quality, cost-effective outcomes and oversee staff across UR activities. The role emphasizes supervising staff, coordinating clinical reviews, and meeting regulatory requirements.

A BSN is required, with RN licensure in NJ and several years of UR-related nursing experience. The position supports department performance improvement, liaises with payers and hospital leadership, and entails a 40-hour work

Qualifications

• Education: BSN required; ADN with experience may be considered.
• Experience: Four years in nursing including case management in utilization review, discharge planning, outcomes management, assessment, care planning and/or care coordination when accompanied by a BSN. Six years of nursing experience with ADN.
• License: Registered Nurse - NJ.
• Knowledge and Skills: Interpersonal, communication and negotiation; ability to interpret instructions; strong organizational and time management; leadership and team-building.
• Special Training: Analytical and data management skills.
• Mental, Behavioral And Emotional Abilities: Usual Work Day: 8 Hours.
• Reporting Relationships: Supervises utilization review staff.

Responsibilities

• Perform daily Utilization Review functions and clinical reviews per guidelines.
• Supervise UR staff and ensure processes follow CH policy.
• Ensure staffing levels and adjust assignments as needed.
• Provide feedback to UR director on department performance.
• Participate in system-wide committees and performance improvement projects.
• Assist in training and mentoring UR staff.
• Participate in regulatory compliance activities (DNV, etc.).
• Maintain and enhance relationships with internal and external customers.

Skills

Interpersonal communication

Negotiation skills

Organizational skills

Time management

Leadership

Data management

Analytical skills

Education

Bachelor of Science in Nursing (BSN)

Job description

Capital Health in New Jersey is seeking an experienced Utilization Review leader to promote quality, cost-effective outcomes and oversee staff across UR activities. The role emphasizes supervising staff, coordinating clinical reviews, and meeting regulatory requirements.

A BSN is required, with RN licensure in NJ and several years of UR-related nursing experience. The position supports department performance improvement, liaises with payers and hospital leadership, and entails a 40-hour work