Utilization Reviewer; RN- Part Time Morristown

Job Description

• Provides timely and thorough clinical information to insurance companies and other intermediaries to secure payer authorizations and avoid denials or reduction in level of care.
• Performs daily surveillance of observation cases and works with PA discussing any barriers to progression of care or discharge.
• Intervenes proactively to avoid denials or delays in authorization.
• Actively communicates information to other CM team members and interdisciplinary teams regarding progress or payer issues related to continued hospitalization and post-acute service associated with the patient’s discharge plan.
• Refers cases and issues to Physician Advisors or Designees in compliance with department procedures with timely follow up as indicated.
• Assists in identification and collection of avoidable days.
• Coordinates with the CM RN and/or CMA to identify and complete the process for CMS required patient notices.
• Completes and documents utilization reviews, physician advisor referrals and other communications related to assigned cases in accordance with department policy and procedure.
• Complies with the Condition of Code 44 process, CMS required patient notices and other regulatory requirements within the utilization management process.
• Maintains proficiency in the application of organization selected clinical review criteria sets evidenced through IRR testing.

• Graduate of an accredited school of nursing - required
• BSN - preferred
• Current RN license - required
• Case Management - Preferred

At Atlantic Health System, our promise to our communities is:
Anyone who enters one of our facilities will receive the highest quality care delivered at the right time, at the right place, and at the right cost. This commitment is also echoed in the respect, development, and opportunities we give to our more than 20,000 team members. Headquartered in Morristown, New Jersey, we are one of the leading non‑profit health care systems in the nation.

• Morristown Medical Center, Morristown, NJ
• Overlook Medical Center, Summit, NJ
• Newton Medical Center, Newton, NJ
• Chilton Medical Center, Pompton Plains, NJ
• Hackettstown Medical Center, Hackettstown, NJ
• Goryeb Children's Hospital, Morristown, NJ
• Centra State Healthcare System, Freehold, NJ
• Atlantic Home Care and Hospice
• Atlantic Mobile Health
• Atlantic Rehabilitation

We also have more than 900 community‑based healthcare providers affiliated through Atlantic Medical Group. Atlantic Accountable Care Organization is one of the largest ACOs in the nation, and we are a member of All Spire Health Partners.

We have received awards and recognition for the services we have provided to our patients, team members and communities. Below are just a few of our accolades:

• 100 Best Companies to Work For (r) and FORTUNE(r) magazine for 15 years
• Best Places to Work in Healthcare - Modern Healthcare
• 150 Top Places to work in Healthcare - Becker's Healthcare
• 100 Accountable Care Organizations to Know - Becker's Hospital Review
• Best Employers for Workers over 50 - AARP
• Gold‑Level "Well Workplace":
  Wellness Council of America (WELCOA)
• One of the 100 Best Workplaces for "Millennia ls" Great Place to Work(r) and FORTUNE(r) magazine
• One of the 20 Best Workplaces in Health Care:
  Great Place to Work(r) and FORTUNE(r) magazine
• Official Health Care Partner of the New York Jets
• NJ Sustainable Business

Morristown Medical Center is a nationally‑recognized leader in cardiology and heart surgery, orthopedics, gynecology, geriatrics, gastroenterology and GI surgery, pulmonology and lung surgery, and urology.

We are the only hospital in New Jersey named one of America’s "50 Best Hospitals" for six consecutive years by Health grades and one of the World's Best Hospitals by Newsweek. We were included on Becker's Healthcare 2020 list of "100 Great Hospitals in America". In addition, Leapfrog recognized us with an "A" hospital safety grade – its highest – twelve consecutive times, and the Centers for Medicare and Medicaid Services awarded us again with its highest five‑star rating in 2020.

Morristown Medical Center is a Magnet Hospital for Excellence in Nursing Service, the highest level of recognition achievable from the American…