Precertification & Pre-Service Appeals Nurse

NJ CURE • Princeton, NJ

16d • $65,000 - $85,000 • Hybrid

About The Position

CURE Auto Insurance is seeking a skilled and motivated Precertification & Pre-Service Appeals Nurse to join our team. In this role, you will be the clinical bridge between provider orders and insurance approval. You will evaluate clinical documentation against medical necessity criteria, secure prior authorizations, and manage the pre-service appeals process. Your clinical expertise will assist with medical management of PIP claims and directly prevent administrative delays to stay in compliance with New Jersey precertification guidelines.

Requirements

• Graduate of an accredited School of Nursing (Associate or Bachelor’s degree).
• Active, unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN/LVN) license in the state of New Jersey.
• Minimum of [2-3] years of clinical nursing experience
• Minimum of [1-2] years of experience in Precertification, Case Management, or Managed Care.
• Detail-oriented with strong written and verbal communication skills.
• Must be organized and have the ability to multitask while prioritizing work.
• Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.

Responsibilities

• Review treatment plans to determine insurance authorization.
• Analyze patient charts, physician notes, and diagnostic results to determine if treatment is appropriate as requested or to escalate to a physician for a review through physician review, peer review, or an Independent Medical Exam.
• In the event of a pre-service dispute, investigate the root cause, compile necessary clinical arguments, and process formal pre-service appeal responses.
• Partner closely with physicians, advanced practice providers, and staff to obtain additional charting documentation or facilitate peer-to-peer reviews. Works closely with PIP representatives on case management.
• Accurately and timely review and document all authorization statuses, reference numbers, and appeal outcomes
• Other related tasks as assigned

Benefits

• Comprehensive health benefits, including medical, dental, and vision coverage
• Generous paid time off (PTO days, sick days, and holidays)
• Flexible spending options with FSA & HSA plans
• Life and AD&D insurance
• 401(k) with company match
• Voluntary benefits such as legal services, pet insurance, and identity & fraud protection
• 24/7 Employee Assistance Program (EAP) for employees and their families
• Health & wellness perks, including gym discounts, wellness reimbursements, and reward programs
• Fun, engaging in-office events that support our culture

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree