New Jersey Licensed Outcomes Manager

Job Summary

To support effective patient outcomes, the full-time salaried New Jersey Licensed Outcomes Manager will manage medical necessity tools, assist in utilization review processes, and ensure compliance, all while working remotely.

Key responsibilities

• Utilize payer-specific screening tools to determine medical necessity and level of service
• Manage concurrent and retroactive denials through collaboration with physicians and multidisciplinary teams
• Document clinical reviews and denial management in relevant systems to ensure compliance and support organizational goals

Required qualifications

• New Jersey Registered Nurse (RN) license required
• 3 years of clinical nursing experience and 1 year of utilization review/case management experience preferred
• Basic understanding of Medicare, Medicaid, and managed care
• Graduate of an accredited School of Nursing; BSN strongly preferred
• Case Management Certification required within one year of hire