Utilization Review Case Manager, Care Coordination, Full Time, Day
The Valley Hospital-Paramusonsitemanager$104K – $130K
Posted today · via Workday
About this role
POSITION SUMMARY: The Utilization Case Manager performs concurrent utilization review to ensure appropriate level-of-care determinations, medical necessity, regulatory compliance, and effective resource utilization. Collaborates with physicians, payers, Physician Advisors, and care coordination staff to support admission status decisions, prevent reimbursement denials, optimize length of stay, and ensure compliance with CMS and payer requirements. Serves as a resource on utilization management, medical necessity criteria, and reimbursement regulations while promoting quality patient outcomes and organizational performance. EDUCATION: Bachelor,s degree (BSN) in nursing required. EXPERIENCE: Current Registered Nurse (RN) License in the State of New Jersey required.…
What we'd score you on
reqspace match rubricFive dimensions, recruiter-grade. Upload your resume and we'll generate a written explanation of where you fit and where the gaps are.
1
Skills match
We compare your skills against the role requirements.
2
Level fit
This role is manager-level. We check your trajectory against it.
3
Domain experience
Your work in the role's domain matters more than your years total. We weight recent and direct experience.
4
Recency
A skill you used last quarter weighs more than one from five years ago. We grade on recency, not lifetime.
5
Location fit
This role is based in The Valley Hospital-Paramus. We weight your proximity and willingness to relocate.
Score yourself on this role.
Free · no card · written explanation included
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