Registered Nurse- UR Manager, Central Utilization Review- Full Time, Days, 8 Am - 4 Pm, Morristown NJ

Job description

Key responsibilities
• Lead, coach, and support the Central UR nurses and Insurance Specialists; manage assignments, workflow priorities, and staff performance.
• Ensure timely initial and continued-stay reviews, authorization follow-up, payer communication, and escalation of cases at risk for denial.
• Partner with physician advisors and care teams on level-of-care questions, peer-to-peer reviews, potential account downgrades, and clinical appeals.
• Analyze denial, appeal, authorization, and UR performance data to identify trends and lead corrective action.
• Work with hospital case management, medical, nursing, and revenue cycle leaders to resolve barriers and improve care progression.
• Identify recurring payer and Independent Review Organization issues and share findings with Managed Care Contracting and appeals leadership.
• Develop clear workflows, education, and tools in response to performance gaps, payer requirements, and regulatory changes.
• Monitor improvement plans and help teams sustain results across AHS hospitals.

Required
• Graduate of an accredited school of nursing with a current Registered Nurse license in the applicable state.
• Bachelors degree in nursing,
• Advanced degree in business, or health care administration preferred.
• Leadership experience in an acute care setting.
• Experience in acute care case management or utilization review.
• Strong clinical judgment, communication, data analysis, and team leadership skills.

Preferred
• ACM-RN or CCM certification.
• Experience with payer authorizations, clinical denials and appeals, and physician advisor workflows.
• Case management training through a professional organization.