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

Medsurg Sales Staffing

Capital monitor Neurosleep Job at Medsurg Sales Staffing

Industry leading company looking for experienced medical equipment rep. Atlanta, Birmingham territory. 45 base and 110k at plan. Car and expense allowances. Top reps making over 150k. First year guarantee.*REQUIREMENTS* Two to five years successful experience in...

group of children parents in Fengtai District, Beijing

Part Time (Every Weekend) English Teacher Needed Job at group of children parents in Fengtai District, Beijing

Part Time (Every Weekend) English Teacher NeededWere a group of children parents in Fengtai District, Beijing, now were looking for 1-2 native English teachers, can teach our kids every SundayWe need someone can teach us 2, or 4 or 6 hours on Saturday and Sunday, morning...

The National Board for Certified Counselors

Learning Management System (LMS) Administrator Job at The National Board for Certified Counselors

..., and assessment department staff to develop and maintain the LMS platform and included components. Provides service to State... ...setup and learning with the LMS system Perform high level administrative functions Oversees, coordinates, monitors, and evaluates daily...

NorthPoint Search Group

Marketing Coordinator - Marietta Job at NorthPoint Search Group

...Coordinator to join our team in our Marietta office with ability to work from home a few days a week. The Content Marketing Coordinator will be... ...: Content creation Create compelling content to engage target audiences through all channels. Use analyzed data to create a...

ScreenRant

News Editor - Network TV Job at ScreenRant

...passionate audience, providing you an exciting opportunity to make a genuine impact. Experience and Skills: ~ Bachelors degree in journalism or a related field. ~2 years of experience in producing entertainment and related content. ~ In-depth familiarity with and...

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

OHNqcGRLMGtOUldXNlJad3h5c3ZkZUtuekE9PQ==