Utilization Review Supervisor - FT - Day - Utilization Resource Mgmt Trenton NJ
Capital Health
- # Utilization Review Supervisor - FT - Day - Utilization Resource Mgmt Trenton NJApplylocations: RMCtime type: Full timeposted on: Posted Todayjob requisition id: JR110713Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.The listed pay range or pay rate reflects compensation for a **full-time equivalent (1.0 FTE)** position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).**Pay Range:**$86,964.80 - $119,714.81**Scheduled Weekly Hours:**40**Position Overview**Performs a variety of utilization management activities to promote quality, clinical and cost-effective outcomes. Supervises activities of assigned staff in providing utilization review services. Plans, assigns, reviews, and evaluates work of assigned staff to achieve quality output, to operate in a fiscally responsible manner and to achieve operational efficiency and to adhere to established policies, practices, and procedures. Identifies opportunities and takes a leadership role in departmental performance improvement activities. Performs as an effective leader.MINIMUM REQUIREMENTS Education: Graduation from an accredited school of nursing. Experience: Three years job related experience. Five years’ experience in clinical nursing. Experience in case management field including utilization review required and/or discharge planning, outcomes management, assessment, care planning, and care coordination. Other Credentials: Registered Nurse - NJ Knowledge and Skills: Good problem solving and reasoning ability skills to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Special Training: Intermediate computer skills. Mental, Behavioral and Emotional Abilities: Ability to interpret a variety of instructions furnished in written, oral, graph, diagram or other format. Ability to manage multiple conflicting priorities effectively and efficiently. Usual Work Day: 8 Hours Reporting Relationships Does this position formally supervise employees? YesIf set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.ESSENTIAL FUNCTIONS Supervises activities of assigned staff in providing case utilization review. Acts as liaison with staff and/or management to handle any problems that arise, identifies alternatives and recommends solutions. Ensures equitable distribution of work assignment on a daily basis, adjusts work assignments throughout shift as needed and accepts staff call-outs and arranges alternate staffing as appropriate. Evaluates staff to enhance their performance, development, and work product. Addresses performance issues ongoing and through annual performance evaluations, and makes recommendations for personnel actions. Motivates and rewards employees according to company guidelines. Participates in interviewing and hiring process of new employees. Ensures quality and performance goals of individual UR RN and department - conducts regular and scheduled reviews of utilization RNs work product including reviews, payer correspondence, and other contacts and documentation. Conducts routine chart reviews for interrater reliability to maintain accuracy of reviews and maintain documentation requirements, provides ongoing feedback to utilization managers and department management regarding individual and department performance. Provides orientation and training of all new Utilization RNs, provides ongoing training and education to all staff members regarding new, evolving and/or changing workflows, timeframes and regulations. Develops training tools as necessary. Serves as liaison for department with physician advisor program, includes problem solving, orientation of new physician advisors, UR RN referral monitoring for accuracy and effectiveness. Serves as primary point of contact for providers within CH for utilization management and level of care questions or issues. Rounds in outpatient areas of responsibility several times a day to ensure timely and accurate exchange of information and reviews. Provides on call support to the 24/7 UR RN staff (telecommuters) who provide UR support to ALL campuses and each ED room. Includes any input needed for transfer center, observation units and ALL EDs. Assists with quarterly education to the medical staff (ED, Residents, Hospitalists) regarding documentation and level of care placement as per MCG guidelines. Creates, manages and maintains the 24/7 UR RN schedule and assures coverage is always available for all ED sites. Creates, manages and maintains the CapitaLink UR RN on call schedule, providing access for the ED MD to the on call UR RN. Provides coverage for all staffing shortages, including nights and weekends. Serves as a member of retrospective PSO adjustment team. Serves as primary liaison for department with finance department regarding billing discrepancies. Manages daily PSO cerner orders/bed day maintenance by assisting finance, logistics and patient access to assure payment issues are resolved effectively and efficiently. Performs other duties as need.PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent physical demands include: Sitting , StandingOccasional physical demands include: Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activitiesContinuous physical demands include: Keyboard use/repetitive motion , Talk or HearLifting Floor to Waist 10 lbs. Lifting Waist Level and Above 10 lbs.Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Depth Perception, Accurate Hearing Anticipated Occupational Exposure Risks Include the following: N/A*IND123.***This position is eligible for the following benefits:*** Medical Plan* Prescription drug coverage & In-House Employee Pharmacy* Dental Plan* Vision Plan* Flexible Spending Account (FSA)- Healthcare FSA- Dependent Care FSA* Retirement Savings and Investment Plan* Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance* Supplemental Group Term Life & Accidental Death & Dismemberment Insurance* Disability Benefits – Long Term Disability (LTD)* Disability Benefits – Short Term Disability (STD)* Employee Assistance Program* Commuter Transit* Commuter Parking* Supplemental Life Insurance- Voluntary Life Spouse- Voluntary Life Employee- Voluntary Life Child* Voluntary Legal Services* Voluntary Accident, Critical Illness and Hospital Indemnity Insurance* Voluntary Identity Theft Insurance* Voluntary Pet Insurance* Paid Time-Off ProgramThe pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.
- J-18808-Ljbffr Capital Health
Vacancy posted 12 hours ago
Similar jobs that could be interesting for youBased on the Utilization Review Supervisor - FT - Day - Utilization Resource Mgmt Trenton NJ in Brooklyn, NY vacancy
- Capital Health seeks an experienced Utilization Review Supervisor for 40 hours/week in Trenton, NJ. The role oversees UR staff, ensures compliant reviews, and collaborates with physicians, finance, and ED teams to optimize care and cost efficiency. Requirements include...SuggestedFull time
$55k - $75k
...Full Time Office/Clerical Remote, US 5 days ago Requisition ID: 5788 Salary Range:... ...post-treatment lives. We are seeking a Utilization Review Coordinator to add to our dynamic team.... ...determine the appropriateness of care and resource utilization. This position collaborates...SuggestedFull timePart timeWork at officeRemote workRed Oak Recovery
Brooklyn, NY4 days ago- ...Job Description Join our team as a day shift/variable, full time, RN Case Manager - Utilization Review, at INTEGRIS Baptist Medical Center, Oklahoma City, OK. Join... ...psychological and financial needs utilizing all available resources. Recommends and coordinates timely transfers to...SuggestedFull timeWork at officeDay shift
INTEGRIS Health
Brooklyn, NY3 days ago - ...experienced Registered Nurse specializing in utilization review to assess non-acute cases. This role... ...records to ensure appropriate care and resource utilization while maintaining... ...administration and review. Benefits Day 1 Medical, Dental, and Vision insurance...Suggested
TactStaff
East Elmhurst, NY1 day ago - ...Baptist Medical Center in Oklahoma City, OK is seeking a day shift/variable, full-time RN Case Manager - Utilization Review. You will assess patients, coordinate transfers, and develop discharge plans to optimize resources and patient outcomes. Qualifications include RN...SuggestedFull timeDay shift
- ...opportunity with us! The Lead Utilization Management Coordinator (UMC)... .... Five (5) years Utilization Review and/or Clinical Appeals and/or... .... Assisting and monitoring day-to-day operations: Assure that... ...- yearly review of staff resources / documents / process flows....Work at officeImmediate startHome officeShift workWeekend work
- ...Details The Case Manager RN utilizes advanced nursing skills... ...care. Functions as a resource to facilitate... ...patient’s hospital stay. Reviews patient length of stay/... ...Licensed Registered Nurse_NJ - State of New Jersey Physical... .... Work Shift Workday Day (United States of...Full timeTemporary workPart timeFlexible hoursShift work
$2,940.02 per month
...Nursing Profession RN Specialty Utilization Review Job ID 19018147 Job Title RN - Utilization... ...Weekly Pay $2940.02 Shift Details Shift 5 Day Shifts X 8 Hrs Scheduled Hours 40 Job Order...Weekly payShift workDay shiftTalent4Health
East Elmhurst, NY3 days ago- ...Skills: ~1 year of non-acute utilization review experience - required ~ RN experience - preferred Certification: New... ...: ~8:30 AM-5:00 PM ~42.50 houris/week ~8.50 hours/day ~5 days/week Department: ~ PATIENT RELATIONS...Shift work
ATD Technology LLC
East Elmhurst, NY2 days ago - ...Obstetrical Nursing - FT - DayApplylocations:... ...Full timeShift:12 Hour Day Shift (United States... ...practice model* Utilizes appropriate resources to plan, provide, and... ...schedules agreed upon with supervisor.* Abide by Stormont... ...Worker Policy and will review and acknowledge the...Remote workDay shift
- ...Clinical UM leader to oversee Prior Authorization, Concurrent Review, and Retrospective Review teams in Ohio, with a focus on ensuring... ...a few times per year. The position emphasizes guiding utilization management operations, developing policies, and collaborating...
Centene Management Company LLC
Brooklyn, NY2 days ago $107k - $130k
Director of Operations & Maintenance- Willingboro Municipal Utilities Authority. Under direction, plans, coordinates and directs operations... ...of Operations & Maintenance to: Willingboro MUA Attn: Human Resources: ****@*****.*** Full-time $107,000 - $130,000 #J-18808-Ljbffr...Full time- ...application process. Lead Designer - Utilities and Central Energy Regular Full Time Cincinnati, OH, US 8 days ago Requisition ID: 1398... ...efforts, and serves as a key resource for resolving complex design challenges... ...goal setting, performance reviews, and ongoing coaching to...Full timeContract workTemporary workFlexible hours
- Utilities Water Operations & Maintenance Manager Job Category : Utilities Requisition Number... ...Direct Reports: Process Maintenance Supervisor, FacilitiesdesignatedResource Technicians... ...employment laws.For further information, please review the Know Your Rights notice from the...Full timeFor contractorsWork experience placementLocal area
$160k - $175k
...benefits offered may include:· Day 1 Medical, supplemental health, dental & vision for FT employees who work 30+ hours· Best... ...and third parties for audits/reviews. Provide leadership and insight... ...Develop benchmarking that can be utilized on audits when assessing regional...Full timePart timeWork experience placementRemote workFlexible hours$114.65k - $189.17k
...Maintenance - Full Time 8 Hour Days (Exempt) (Non-Union)... ...technical design and/or construction reviews and reports.* Ensures compliance... ...of contracts.* Serves as key resource for project information and resolves... ....* Demonstrates ability to utilize effective, appropriate and...Full timeFor contractorsFor subcontractorRelocation$38.8 per hour
...role is responsible for kitting resources—labor, parts, and tools— to... ...safety. Current Opening on Day shift: Monday - Friday: 6:30... ...repairs. Work Order Management: Review, prioritize, and schedule all... ...(SAP) to maximize equipment utilization. Documentation and Job Planning...For contractorsApprenticeshipMonday to FridayDay shift- ...position Title: Coordinator, Utilization Management Location: Remote (... ...within allocated timeframe. Review timely filing guidelines regarding... ...terminal for 6-8 hours a day and function in an environment... ...may be assigned by supervisors as deemed appropriate. Company...Temporary workImmediate startRemote workShift work
- Utilities Work Coordinator - Choke Canyon Dam - 11077 Overview The Work Coordinator leads and... ...procurement, leasing, outsourcing, resource costs, and operational needs Serves as Project... ...a valid Texas driver's license within 90 days of hiring. TCEQ Dam Safety Training...Full timeFor contractorsWeekend workAfternoon shift
- ...RN - Utilization ReviewNumber of Positions: 1Remaining Positions: 1Duties: 1 year of non-acute utilization review experience - required RN experience - preferred This is the pay range that RightSourcing (a part of Magnit) reasonably expects to pay someone for this position...
Compu-Vision Consulting
East Elmhurst, NY1 day ago $55 - $65 per hour
...Registered Nurse With Utilization Review ExperienceA healthcare organization is seeking a Registered Nurse with utilization review experience to support non-acute clinical review activities. This contract opportunity is based in the Queens, NY area and requires an active...Hourly payContract workATRIA Consulting
East Elmhurst, NY10 hours ago$100k - $140k
...nursing leader with a passion for utilization management, operational... ...a subject matter expert and resource for UM staff, providing ongoing... ...schedule, working in office three days per week. Occassional travel... ...further information, please review the Know Your Rights notice...Contract workWork at officeMonday to FridayWeekend work3 days per week- Cedar Creek Hospital in Michigan is seeking a Manager of Utilization Review to lead the Utilization Review Program for inpatient and outpatient services. This role supervises the department’s staff and helps develop and implement case management processes to ensure effective...
- ...the field we are seeking qualified applicants for a Manager of Utilization Reviewposition. Learn more about Cedar Creek Hospital online... ...: Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and overseeing the Utilization Review...Local area
$23.76 - $51.49 per hour
...DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services... ...teams to promote the Molina care model. Adheres to utilization management (UM) policies and procedures. Required Qualifications...Hourly payWork experience placementWork at officeMolina Healthcare
Brooklyn, NY1 day ago- ...States Job Description We are seeking a Utility & Sustainability Solutions Lead to support... ...ingestion, bill validation, tariff review, invoice approvals, exception management,... ...client stakeholders. Act as a subject‑matter resource for client sustainability, energy, finance...Local areaFlexible hours
$60.2k - $107.4k
...care, pharmacy benefits, data and resources they need to feel their best.... .... Growing together. The Utilization Management Nurse will accurately and efficiently review and extract pertinent case details... ...posted for a minimum of 2 business days or until a sufficient candidate...Minimum wageFull timeWork experience placementLocal areaRemote workMonday to FridayFlexible hoursWeekend workAfternoon shift- Palmetto GBA, LLC is seeking a registered nurse to perform medical claim reviews using clinical information and established guidelines. You will document decisions and support medical claims and utilization practices. This full-time, remote role operates Monday-Friday, 8:00...Full timeRemote workMonday to Friday
$60.2k - $107.4k
UnitedHealth Group is looking for an Utilization Management Nurse to review medical records, extract case details, and craft defensible appeal letters. The role emphasizes data extraction, template use, and adherence to HIPAA and company policies. The position requires...Remote job$60.2k - $107.4k
Optum is a global healthcare organization empowering care through technology. The Utilization Management Nurse role involves reviewing medical records, extracting case details, and crafting defensible appeal letters according to process instructions and guidelines. The...Remote jobFull timeMonday to Friday
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review Supervisor - FT - Day - Utilization Resource Mgmt Trenton NJ. Be the first to apply!
Related searches
- resource coordinator Brooklyn, NY
- community resource specialist Brooklyn, NY
- clinical resource coordinator Brooklyn, NY
- family resource specialist Brooklyn, NY
- resource manager Brooklyn, NY
- resource deployment manager
- creative resource coordinator
- creative resource manager
- resource coordinator
- clinical resource director