Utilization Review RN - Clinical Resource Manager
Capital Health System, Inc.
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Résumé du poste
Capital Health System, Inc. is seeking a Utilization Review RN to perform clinical review, chart reviews, and admission reviews for payer determination. The role focuses on promoting quality and cost-effective care within CMS and local guidelines.
The position requires an Associate's degree in Nursing, RN licensure, and 2–3 years of related experience. Strong computer skills, EMR proficiency, and UR software expertise are preferred. Excellent benefits and a comprehensive pension plan are offered.
Qualifications
- Minimum of Associate's degree in Nursing. Graduate of an accredited school of nursing.
- Three years of clinical nursing or two years quality management, utilization review or discharge planning experience.
- Registered Nurse - NJ knowledge and skills.
- Basic computer skills including Microsoft Office, UR software and EMR.
Responsabilités
- Performs utilization and resource management to promote quality and cost-effective outcomes.
- Reviews patient treatment plans with third party payers and care team.
- Identifies and implements strategies to reduce length of stay and resource use.
- Participates in performance improvement activities and care coordination.
Connaissances
Formation
Outils
Description du poste
Capital Health System, Inc. is seeking a Utilization Review RN to perform clinical review, chart reviews, and admission reviews for payer determination. The role focuses on promoting quality and cost-effective care within CMS and local guidelines.
The position requires an Associate's degree in Nursing, RN licensure, and 2–3 years of related experience. Strong computer skills, EMR proficiency, and UR software expertise are preferred. Excellent benefits and a comprehensive pension plan are offered.
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