Utilization Review RN – Care Optimization

Capital Health (US); Pennington (NJ); On-site; USD 64,000 - 107,000; Full time

Benefits offered by this job

Medical Plan

Dental Plan

Vision Plan

Paid Time-Off Program

Job summary

Capital Health is seeking a Registered Nurse with strong background in utilization management to help promote quality and cost-effective patient care. The role requires experience in chart reviews, admissions/discharge reviews and collaboration with care teams to optimize resources.

Ideal candidates have five years of clinical nursing and three years in quality management or UR, with NJ RN licensure. The position offers full-time hours and comprehensive benefits in a dynamic healthcare setting.

Qualifications

• Associate's degree in nursing required.
• Five years' clinical nursing experience and three years in quality management, utilization review or discharge planning.
• Registered Nurse - NJ.
• Basic computer skills including MS Office, UR software and EMR.

Responsibilities

• Perform chart reviews to assess quality, timeliness and appropriateness of patient care.
• Conduct admission reviews for Medicare, Medicaid and other payers.
• Collaborate with care team to optimize length of stay and resource use.
• Participate in utilization reviews and industry guidelines compliance.
• Engage with medical staff and case managers to resolve barriers to progression of care.

Skills

Nursing

Quality management

Utilization review

MS Office

Education

Associate's degree in nursing

CPHQ/CCM/CPUR preferred

Tools

UR software

EMR

Job description

Capital Health is seeking a Registered Nurse with strong background in utilization management to help promote quality and cost-effective patient care. The role requires experience in chart reviews, admissions/discharge reviews and collaboration with care teams to optimize resources.

Ideal candidates have five years of clinical nursing and three years in quality management or UR, with NJ RN licensure. The position offers full-time hours and comprehensive benefits in a dynamic healthcare setting.