Nurse Registered Utilization Management

St. Joseph's Health • Paterson, NJ

3d

About The Position

The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiecny of healthcare services in accordance with established criteria, regulatory requirements, and organizational role. The UM RN ensures optimal patient care delivery while supporting compliance, quality outcomes, and effective resource utilization. The role is responsible for the assessment of medical necessity, both for admission to the hospital as well as continued stay. This function ensurses that services are not only appropriate but ensures that an authorization is obtained from the payer, if required, and that the documentation supports the care delivered in such a way that minimzes risks of denials

Requirements

• Work requires the knowledge of theories, principles, and concepts normally acquired through completion of a Bachelor of Science in Nursing
• at least 3 years of previous nursing experience
• Licensure required as a Registered Nurse by the State of New Jersey.

Nice To Haves

• 3+ years of Utiliziation Review or Case Management experience
• Case Management Society of America Certification CCM preferred

Responsibilities

• evaluating the medical necessity, appropriateness, and efficiecny of healthcare services
• assessment of medical necessity for admission to the hospital as well as continued stay
• ensuring services are appropriate
• ensuring authorization is obtained from the payer, if required
• ensuring documentation supports the care delivered in such a way that minimzes risks of denials

What This Job Offers

• Job Type: Full-time