Utilization Review Nurse

1 week ago


Paramus, New Jersey, United States VNS Health Full time
Utilization Review Registered Nurse

VNS Health is seeking a skilled Registered Nurse (RN) to join our team in North Bergen, New Jersey. As a Utilization Review Registered Nurse, you will play a critical role in providing compassionate care and expert services to our community.

Key Responsibilities:
  • Investigate and review routine and complex situations to analyze and solve problems related to grievances and appeals.
  • Coordinate the resolution of routine and complex grievances and appeals according to defined processes and procedures.
  • Review covered and coordinated services to ensure appropriate appeal resolution and execution of the plan's fiduciary responsibilities.
  • Coordinate external case reviews requested by enrollees and track external reviews throughout the process.
  • Collaborate with professionals, health plan departments, and legal teams to investigate and facilitate resolution of individual grievances and appeals.
Requirements:
  • License and current registration to practice as a registered professional nurse in New York State required.
  • Bachelor's Degree or Master's Degree in Nursing preferred.
  • Minimum three years progressive professional experience in healthcare, including a minimum of two years in grievance and appeals or related area.
  • Proficient verbal/written communication skills required.
  • Proficient computer and typing skills and knowledge of Microsoft Office (Word and Excel) required.


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