Outcomes Manager - UR (Per Diem)

Job Summary Responsible for applying appropriate medical necessity tools to maintain compliance and achieve cost‑effective, patient‑centered outcomes. Acts as a resource to other team members, including UR Tech and AA, to support utilization review and revenue cycle processes. Position Responsibilities Utilization Management Utilize payer‑specific screening tools to determine level of service and medical necessity. Consult with Physician Advisor about medical necessity, length of stay, and appropriateness of care. Identify and manage concurrent and retroactive denials through communication with physicians, case management, multidisciplinary teams, external physician resource groups, and payers. Documentation – Provide accurate and complete clinical review and denial management documentation in the case management and billing systems. Denial Management Manage concurrent denial processes, referring to appropriate resources for concurrent and retrospective appeal activities. Prepare and facilitate audits using appropriate screening tools and documentation. Metrics – Accountable to job‑specific goals, objectives, and dashboards; participate in improvement activities such as patient satisfaction, Six Sigma committee, and community initiatives. Compliance – Understand and apply applicable federal and state requirements; identify and report compliance issues as needed. Position Qualifications Required Experience : Graduate of an accredited School of Nursing; RN licensure in New Jersey. Preferred Experience : 3 years clinical nursing (RN) experience and 1 year utilization review / case management / quality management experience, **or** 3 years experience as a Clinical Social Worker. 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. Case Management Certification required within one year of hire (beginning April1,2015). Education & Licensure Graduate of an accredited School of Nursing. New Jersey Registered Nurse license. Compensation Hourly Rate: $38.33 – $59.58 (dependent on experience and internal equity). Benefits Medical, prescription, dental, and vision insurance. Health and dependent care flexible spending accounts. 403(b) retirement plan (401(k) subject to collective bargaining). Paid time off, paid sick leave per state and local laws, short‑term and optional long‑term disability. Life and AD&D insurance, supplemental life and AD&D. Tuition assistance and employee assistance program with free counseling sessions. #J-18808-Ljbffr Virtua Medical Group