New Jersey Licensed Outcomes Manager

Job Summary

A company is looking for an Outcomes Manager/Utilization Review, RN, Full Time.

Key Responsibilities

• Utilize payer-specific screening tools to determine medical necessity and level of service
• Manage concurrent and retroactive denials through collaboration with multidisciplinary teams and external resources
• Ensure compliance with federal and state regulations and participate in organizational improvement activities

Required Qualifications

• Registered Nurse (RN) with 3 years of clinical nursing experience and 1 year of utilization review/case management experience preferred
• Basic understanding of Medicare, Medicaid, and managed care
• Experience in discharge planning or home health preferred
• Graduate of an accredited School of Nursing; BSN strongly preferred
• Licensure from the State of New Jersey as a Registered Nurse; Case Management Certification required within one year of hire