Clinical Resource Management Nurse, RN
2 weeks ago
POSITION OVERVIEW:
About Christian Health Care Center:
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, and we continue to deliver quality services to our residents, patients, and clients.
Caring is not just our profession; it is our identity.Why Become Part of Our Team:
With four campuses, eleven communities, five service offerings, and a hospital, we operate as one cohesive team.
We foster a compassionate and collaborative environment that encourages continuous improvement, allowing our team members to develop, thrive, and excel in their careers.
Join a team that is committed to making a meaningful impact in the lives of others.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 the effective utilization and oversight of healthcare resources to achieve optimal clinical, financial, and resource outcomes.
This role includes verifying insurance coverage eligibility, understanding benefit details, and ensuring compliance with pre-certification and authorization requirements.It is essential to maintain accurate insurance information within the medical records.
Collaboration with the interdisciplinary treatment team is crucial to review managed care documentation for compliance in a timely manner.
The nurse will ensure that the medical records for patients admitted to RRBH meet the medical necessity criteria for each level of care.Timely and precise clinical reviews are necessary to ensure adherence to managed care organizations.
The nurse will also follow up on any managed care denials to assess the risk and benefit of appeals.Understanding and embracing the mission of Christian Health Care Center is fundamental to this role.
WORK SCHEDULE:
Full-time, Monday - Friday, 8am – 4pm
EDUCATIONAL REQUIREMENTS:
Must be a graduate of an accredited nursing program. A valid RN license in New Jersey is required. A Bachelor's degree in nursing is preferred. Experience in Utilization Review is essential.
Christian Health Care Center 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.
QUALIFICATIONS AND REQUIREMENTS:
Must demonstrate compliance with the CH ASPIRE Standards of Performance.
Required Qualifications:
Valid RN license in New Jersey is mandatory.
A Bachelor's degree in nursing is preferred.
Experience in Utilization Review is required.
If you are interested in this opportunity, please explore our website for more information.
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