Nurse Registered Utilization Management at St. Joseph's Health

Paterson, New Jersey, United States -

Full Time

Start Date

Immediate

Expiry Date

26 Aug, 26

Salary

73.77

Posted On

28 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization Management, Medical Necessity Assessment, Case Management, Patient Care Delivery, Regulatory Compliance, Resource Utilization, Clinical Documentation, Payer Authorization

Industry

Hospitals and Health Care

Description

The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency 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 ensures 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 minimizes risks of denials. St. Joseph’s Health is recognized for the expertise and compassion of its highly skilled and responsive staff. The combined efforts of the organization’s outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation’s “100 Best Places to Work in Health Care”. Benefits Eligibility: (Full-time and Part-time Employees-over 20 hours a week) * Competitive salary* * Robust benefits with health, dental, Rx and vision plans * 403b retirement plan options with company match** * Health & Wellness* * Non-Profit Health System – eligible for Federal Student Loan Forgiveness * PTO, and paid holidays * Tuition reimbursement * Employee Assistance Program * LTD : Long Term Disability * Life Insurance Options * Onsite Day care Program *Available for Per Diem Employees and Part-time Employees working under 20 hours per week. **403b Company Match not applicable for Per Diem Employees and Part-time Employees working under 20 hours per week. Pay transparency: St. Joseph’s Health provides a salary range to comply with New Jersey Law. The rate of pay for each position will be determined based on a variety of factors including the candidate's relevant experience, qualifications, skills, etc.” The salary range does not include incentives, differential pay or other forms of compensation. St. Joseph’s University Medical Center is an academic tertiary care medical center and state designated trauma center, located on the Paterson campus, regularly accepts referrals of difficult or unusual cases from other hospitals and physicians and performs both complex and routine procedures. The Medical Center offers a full complement of specialty and subspecialty services including ambulatory, behavioral health, cardiovascular, emergency/trauma, internal medicine, neuroscience, oncology, orthopedic/spine, rehabilitation, surgical specialty, women’s health, imaging and pediatrics. The nursing team at St. Joseph’s University Medical Center, which includes St. Joseph’s Children’s Hospital, has held the Magnet Award for Nursing Excellence, the profession’s highest honor, since 1999. They are also recipients of the prestigious 2010 Magnet Prize™ - one of only 8 Magnet-designated hospitals to ever receive The Magnet Prize, and the only one worldwide to receive the 2010 award.

Responsibilities

The UM RN evaluates the medical necessity and efficiency of healthcare services to ensure optimal patient care and resource utilization. They are responsible for assessing admissions and continued stays while securing necessary payer authorizations to minimize denial risks.