Utilization Reviewer (RN)- Full Time, Days, 8 AM - 4 PM, Emergency Department, Atlantic Health Morri

JOB DESCRIPTION

Provides timely and thorough clinical information to insurance companies and other intermediaries to secure payer authorizations and avoid denials or reduction in level of care. Performs daily surveillance of observation cases and works with PA discussing any barriers to progression of care or discharge. Intervenes proactively to avoid denials or delays in authorization. Actively communicates information to other CM team members and interdisciplinary teams regarding progress or payer issues related to continued hospitalization and post-acute service associated with the patients discharge plan. Refers cases and issues to Physician Advisors or Designees in compliance with department procedures with timely follow up as indicated Assists in identification and collection of avoidable days Coordinates with the CM RN and/or CMA to identify and complete the process for CMS required patient notices. Completes and documents utilization reviews, physician advisor referrals and other communications related to assigned cases in accordance with department policy and procedure. Complies with the Condition of Code 44 process, CMS required patient notices and other regulatory requirements within the utilization management process. Maintains proficiency in the application of organization selected clinical review criteria sets evidenced through IRR testing

QUALIFICATIONS

Graduate of an accredited school of nursing - required BSN - preferred Current RN license - required Case Management - Preferred

ABOUT US

At Atlantic Health, our promise to our communities is; Anyone who enters one of our facilities will receive the highest quality care delivered at the right time, at the right place, and at the right cost. This commitment is also echoed in the respect, development and opportunities we give to our more than 22,000 team members. Headquarters in Morristown, New Jersey, we are one of the leading non-profit health care systems in the nation. Our facilities and sites of care include: Atlantic Health Morristown Medical Center, Morristown, NJ Atlantic Health Overlook Medical Center, Summit, NJ Atlantic Health Newton Medical Center, Newton, NJ Atlantic Health Chilton Medical Center, Pompton Plains, NJ Atlantic Health Hackettstown Medical Center, Hackettstown, NJ Atlantic Health Goryeb Children's Hospital, Morristown, NJ Atlantic Health CentraState Healthcare System, Freehold, NJ Atlantic Medical Group Atlantic Visiting Nurse Atlantic Mobile Health Atlantic Rehabilitation We have more than 900 community-based healthcare providers affiliated through Atlantic Medical Group. We have received awards and recognition for the services we have provided to our patients, team members and communities. Below are just a few of our accolades: Chosen for 17 years by Fortune as one of the magazine's "100 Best Companies to Work For." Atlantic Health Morristown and Atlantic Health Overlook Named by Newsweek as two of the "World's Best Hospitals" in 2026. Atlantic Health Morristown and Atlantic Health Overlook ranked within the top three hospitals in New Jersey by U.S. News & World Report's 2025-2026 Best Hospital rankings. Atlantic Health scored four "A" grades by The Leapfrog Group in its Fall 2025 Hospital Safety Grades, performance measures reflecting errors, accidents, injuries and injections, as well as systems hospitals have in place to prevent harm. Atlantic Health Morristown and Atlantic Health Overlook are New Jersey's only hospitals to be named among America's 50 Best hospitals by Healthgrades in 2026. Named by Becker's Healthcare as one of the "165 Top Places to Work in Healthcare - 2026." Atlantic Health Morristown, Atlantic Health Overlook, Atlantic Health Chilton and Atlantic Health Newton all Forbes Top Hospitals for 2026. Named by Newsweek as one of America's Greatest Workplaces for Inclusion & Diversity 2025. Atlantic Health rated LEVEL 9 - 2025 CHIME Digital Health Most Wired. Atlantic Health offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members. Offerings vary based on role level (Team Member, Director, Executive). Below is a general summary, with role-specific enhancements highlighted: Team Member Benefits Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full-time and part-time team members) Life & AD&D Insurance. Short-Term and Long-Term Disability (with options to supplement) 403(b) Retirement Plan: Employer match, additional non-elective contribution PTO & Paid Sick Leave Tuition Assistance, Advancement & Academic Advising Parental, Adoption, Surrogacy Leave Backup and On-Site Childcare Well-Being Rewards Employee Assistance Program (EAP) Fertility Benefits, Healthy Pregnancy Program Flexible Spending & Commuter Accounts Pet, Home & Auto, Identity Theft and Legal Insurance Note: In Compliance with the NJ Pay Transparency Act (effective Sunday, June 1, 2025), all job postings will include the hourly wage or salary (or a range), as well as this summary of benefits. Final compensation and benefit eligibility may vary by role and employment status and will be confirmed at the time of offer.

EEO STATEMENT

Atlantic Health, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran #J-18808-Ljbffr Atlantic Health System