Utilization Management Registered Nurse

Job 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. Qualifications Work requires the knowledge of theories, principles, and concepts normally acquired through completion of a Bachelor of Science in Nursing and at least 3 years of previous nursing experience. Preferred 3+ years of Utilization Review or Case Management experience. Case Management Society of America Certification CCM preferred. Licensure required as a Registered Nurse by the State of New Jersey. About Us 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 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. About The Team 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. #J-18808-Ljbffr St. Joseph's Health