Clinical Utilization Review Nurse
About This Role The Valley Health System is seeking a highly skilled RN Utilization Case Manager to join our team. As a key member of our utilization review team, you will be responsible for conducting concurrent reviews on patients within your assigned caseload. You will work closely with medical staff to educate them on appropriate utilization review guidelines and documentation in accordance with CMS regulations and commercial payor guidelines. Your responsibilities will include monitoring and intervening on length of stay, resource utilization, and denial management/prevention within your assigned caseload. Requirements Bachelor's degree in nursing (BSN) is required Minimum 5 years experience in clinical nursing and 3 years in case management/utilization are necessary Registered Nurse licensure in New Jersey is mandatory Key Skills Effective interaction and communication skills are essential Strong critical thinking, clinical reasoning skills, and effective problem-solving abilities are crucial Ability to work accurately and pay attention to details in a fast-paced environment is vital Collaborative team player with excellent interpersonal skills is required
Compensation
Based on national averages for Registered Nurses in New Jersey with similar experience, the salary estimate is $83,434 - $113,997 per year. Apply Job!