Utilization Management Registered Nurse

St. Joseph's Health • Paterson, NJ

3d • $49 - $74

About The Position

The Utilization Management Registered Nurse (UM RN) evaluates the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria, regulatory requirements, and the organization’s role. The position supports optimal patient care delivery, compliance, quality outcomes, and effective resource utilization.

The UM RN assesses medical necessity for hospital admission and continued stay. This work ensures services are appropriate, obtains payer authorization when required, and supports documentation of delivered care to minimize denial risk.

Requirements

• Bachelor of Science in Nursing.
• At least 3 years of previous nursing experience.
• Registered Nurse licensure in the State of New Jersey.

Nice To Haves

• At least 3 years of Utilization Review or Case Management experience.
• Case Management Society of America Certification (CCM).

Responsibilities

• Evaluate the medical necessity, appropriateness, and efficiency of healthcare services using established criteria and regulatory requirements.
• Assess medical necessity for hospital admission and continued stay.
• Ensure payer authorization is obtained when required.
• Ensure documentation supports the care delivered and helps minimize denial risk.
• Support optimal patient care delivery, compliance, quality outcomes, and effective resource utilization.

Benefits

• Competitive salary.
• Health, dental, prescription drug, and vision plans.
• 403(b) retirement plan options with company match, subject to stated eligibility limitations.
• Health and wellness benefits.
• Eligibility for Federal Student Loan Forgiveness through the nonprofit health system.
• Paid time off and paid holidays.
• Tuition reimbursement.
• Employee Assistance Program.
• Long-term disability coverage.
• Life insurance options.
• Onsite day care program.

What This Job Offers

• Job Type: Full-time