Virtua Health is hiring an Outcomes Manager/Utilization Review Registered Nurse to ensure the delivery of compliant, cost-effective, and high-quality patient care. You will be responsible for applying medical necessity tools and acting as a key resource to support utilization review and revenue cycle processes.
What You'll Do
- Utilize payer-specific screening tools to assist in determining the level of service and medical necessity.
- Consult with the Physician Advisor on medical necessity, length of stay, and appropriateness of care.
- Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, the multidisciplinary team, and payers.
- Complete appropriate documentation of clinical review and denial management in case management and billing systems.
- Manage the concurrent denial process by referring cases for concurrent and retrospective appeal activity.
- Prepare and facilitate audits using appropriate screening tools and documentation.
- Accountable to job-specific goals, objectives, and dashboards that contribute to organizational success.
- Participate in organizational improvement activities including patient satisfaction initiatives, committees, and community events.
- Understand and apply applicable federal and state requirements.
- Identify and report compliance issues as appropriate.
What We're Looking For
- Registered Nurse (RN) required.
- 3 years of clinical nursing (RN) experience.
- Basic understanding of Medicare, Medicaid, and managed care.
- Discharge planning or home health background.
- Excellent verbal and written communication skills, problem-solving, critical thinking, and conflict resolution.
- Graduate of an accredited School of Nursing.
- Licensure from the State of New Jersey as a Registered Nurse.
- Case Management Certification (required within one year of hire).
- Exhibits Virtua’s STAR Standards to create an outstanding patient experience.
- Demonstrates Virtua values in all interactions.
Nice to Have
- BSN strongly preferred.
- 1 year of UR/CM/QM experience preferred.
Benefits & Compensation
- Salary: $77,405 - $123,574
- Medical/prescription, dental, and vision insurance
- Health and dependent care flexible spending accounts
- 403(b) retirement plan
- Paid time off
- Paid sick leave as provided under state and local laws
- Short-term disability and optional long-term disability
- Colleague and dependent life insurance and supplemental life/AD&D insurance
- Tuition assistance
- Employee assistance program including free counseling sessions
Work Mode
This is a hybrid position open to candidates in AZ, CT, DE, FL, GA, ID, KY, MD, MO, NC, NH, NJ, NY, PA, SC, TN, TX, VA, WI, WV.
Virtua Health is an equal opportunity employer.
