Job Description

About Us
At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development.
Discover why Cooper University Health Care is the employer of choice in South Jersey.
Short Description
Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity.
Performs utilization review in accordance with all state mandated regulations.
Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues.
Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers.
Completes documentation of review and denial processes in the EPIC Case Management Module
Responds to requests from the payer for all required information and treatment plans.
Reviews and validates physician’s orders, reports progress and unusual occurrences on patients to the payer.
Experience Required
3-5 years of recent clinical experience, preferably in area of population specialty.
Experience in utilization management or review preferred.
Knowledge and understanding of disease protocols and clinical pathways for commercial and government payors. Familiarity with Interqual and Millimen guidelines and regulatory mandates preferred.
Strong communication (written and verbal) and critical thinking skills required. Professional and effective presentation skills required.
Education Requirements
BSN preferred
License/Certification Requirements
Current NJ-RN License required
Special Requirements
Effective problem-solving skills, including the ability to analyze complex situations, draw conclusions and implement actions appropriately and efficiently.

Job Tags

Full time, Part time,

Similar Jobs

Capital One

Marketing Manager, Capital Markets & Investment Banking - Commercial Banking Job at Capital One

...Marketing Manager, Capital Markets & Investment Banking - Commercial Banking About Capital One Commercial Banking We're a top U.S. Commercial Bank committed to helping our clients succeed by providing access to tailored financial solutions, enabling them to transact...

Houston Methodist

Patient Sitter- Flex Pool HMH Job at Houston Methodist

At Houston Methodist, the Patient Sitter position functions as competent and demonstrates knowledge and skills necessary to communicate appropriately and carry out delegated nursing assistant level tasks for assigned age-specific, diverse patient population, providing...

MARA

Executive Assistant Job at MARA

...Executive Assistant We are seeking a highly organized and detail-oriented remote executive assistant sitting in CST/EST to support the Chief Accounting Officer, General Counsel, and SVP of FP&A and Treasury, in close partnership with the Director, Office of the CFO....

Speechify

Senior Software Engineer, Web (JS/TS/React) Job at Speechify

...quickly to generate ideas and know how to decide which things can ship now and what things need time Focus. Were a high-growth startup with a busy, remote team. You know how and when to engage or be heads down Collaboration. You know how to inspire, play, and negotiate...

Total Deployment Solutions

GPU & Structured Cabling Project Manager Salt Lake City, Utah Job at Total Deployment Solutions

...GPU & Structured Cabling Project Manager Salt Lake City, Utah Overview We are seeking a highly motivated and detail-oriented GPU & Structured Cabling Project Manager to oversee and execute structured cabling projects in high-performance data center environments...

CLINICAL REVIEWER RN Job at Cooper University Health Care, Camden, NJ

T20wd1lUM0dzS3J4eW1TQm9BWVBQeFY4M1E9PQ==