Clinical Resource Management Nurse

1 week ago


Wyckoff, New Jersey, United States Christian Health Full time

About Christian Health:

For over a century, we have been dedicated to providing care for those in need. Our foundation is built on the belief that everyone deserves exceptional healthcare. Today, we continue to deliver quality services to our residents, patients, and clients. Caring is not just our profession; it is our identity.

Why Work With Us:

Across our diverse campuses and service offerings, we function as a cohesive team. We foster a supportive and collaborative environment that encourages continuous improvement, allowing our team members to develop and excel in their careers. Surround yourself with individuals who are passionate about making a positive impact.

We are currently seeking a Clinical Resource Management Nurse to join our team at Ramapo Ridge Behavioral Health (RRBH). The Clinical Resource Management Nurse is responsible for promoting the effective use and oversight of healthcare resources to achieve optimal clinical, financial, and operational outcomes. This role involves verifying insurance coverage eligibility, understanding benefit details, and ensuring compliance with pre-certification and authorization requirements. The nurse will ensure that accurate insurance information is documented in the medical records.

Collaboration with the interdisciplinary treatment team is essential to review managed care documentation for compliance in a timely manner. The nurse will ensure that medical records for patients admitted to RRBH meet the medical necessity criteria for various levels of care. This position also requires timely and precise clinical reviews to maintain compliance with managed care organizations, as well as follow-up on any managed care denials to assess the risk and benefit of appeals.

Schedule: Full-time, Monday - Friday, 8am – 4pm.

Qualifications:

  • Active RN license in New Jersey is required.
  • Bachelor's degree in nursing is preferred.
  • Experience in Utilization Review is essential.

Education:

  • Graduate of an accredited nursing program.
  • Active RN license in New Jersey is required.
  • Bachelor's degree in nursing is preferred, along with Utilization Review experience.

Christian Health provides a comprehensive benefits package for full-time employees, including Health Insurance, a Dental Program, Paid Vacation and Holidays, 401k, Life Insurance, Tuition Reimbursement, Employee Assistance Program, and Direct Deposit.

If you are interested in this opportunity, we encourage you to explore further.



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