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Utilization Review Nurse, RN

Christian Health • Full-time • Wyckoff, NJ, US • 2w ago

JOB SUMMARY

About Christian Health:We have had the privilege of caring for those in need for more than a century. Founded on the belief that everyone has the right to exceptional care, today we continue to provide quality care and services for our many residents, patients, and clients. Caring is not simply what we do, it is who we are.

Why Join Our Team:Across our three campuses, ten communities, three service offerings, and hospital, we are ultimately one unified team. Together, we nurture a compassionate, collaborative culture that enables continuous improvement and allows our team members to learn, grow, and shine in their careers. Surround yourself with people who care about making a difference – come join us!

We have an exciting opportunity for a Utilization Review Nurse to work in Ramapo Ridge Behavioral Health (RRBH). The Utilization Review Nurse promotes effective utilization and monitoring of health care resources to achieve desired clinical, financial and resource outcomes. Verifies all insurance coverage eligibility, benefit details, pre certification/authorization requirements and billing/claims instructions. Ensures accurate insurance data is available in the medical record. Works collaboratively with the interdisciplinary treatment team to review all managed care medical record documentation for compliance as required in a timely manner. Ensures that medical record documentation for patients admitted to RRBH meets medical necessity criteria for each level of care. Provides for timely and accurate clinical reviews as required to ensure compliance with managed care organizations. Follows up and assesses any managed care denials for risk/benefit of appeal. Demonstrates an understanding of, and embraces, the mission statement of the Christian Health.

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

Education: Graduate of an accredited school of nursing. Valid RN license in New Jersey required. Bachelor's degree in nursing preferred.

Christian Health offers a wide variety of benefits to full-time employees that includes Health Insurance, a Dental Program, Paid Vacation and Holidays, 401k, Life Insurance, Tuition Reimbursement, Employee Assistance Program and Direct Deposit.

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