NJ Licensed Utilization Review RN

Job Summary

A company is looking for a Remote UM Appeals RN.

Key Responsibilities

• Assesses medical necessity for inpatient stays, procedures, and services using InterQual and plan guidelines
• Coordinates treatment plans with patients, families, physicians, hospitals, and external providers
• Manages UM appeals process and communicates with multidisciplinary teams

Required Qualifications

• Active NJ single state or NJ Compact RN License required
• Minimum of two (2) years clinical experience
• UM Appeals experience (must be clearly documented)
• Must reside in NJ, PA, NY, CT, or MD
• Proficiency with MS Office (Word, Excel, PowerPoint) and intranet/internet applications