Utilization Review Nurse

2 weeks ago


Pennington, New Jersey, United States Capital Health (US) Full time
Job Title: Utilization Review Nurse

Capital Health is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate level of care while minimizing unnecessary costs.

Key Responsibilities:
  • Conduct thorough chart reviews to identify quality, timeliness, and appropriateness of patient care.
  • Perform admission reviews for Medicare, Medicaid beneficiaries, and private insurers to determine the need for inpatient level of care or observation services.
  • Collaborate with physicians and other healthcare professionals to develop and implement strategies to reduce length of stay and resource consumption.
  • Stay up-to-date on regulatory changes and national coverage determinations to ensure compliance and provide expert advice to physicians.
  • Participate in performance improvement activities and contribute to the development of evidence-based protocols and order sets.
Requirements:
  • Minimum of Associate's degree in Nursing and current RN licensure in NJ.
  • Three years of clinical nursing experience or two years of quality management, utilization review, or discharge planning experience.
  • Basic computer skills, including Microsoft Office and EMR, and familiarity with MCG guidelines.
What We Offer:

Capital Health offers a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and detail-oriented nurse with a passion for quality patient care, we encourage you to apply for this exciting opportunity.



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