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
Bachelor’s degree in nursing preferred
License/Certification Requirements
Current NJ-RN License required

Job Tags

Full time, Part time,

Similar Jobs

McMaster-Carr

Publishing Analyst Job at McMaster-Carr

...We are currently seeking a Publishing Analyst to contribute to the exciting changes were making to our publications and products. We... ...Carr tend to share some of the same qualities: A history of academic and professional success At least 2 years of professional experience...

Stanford University

Research Assistant for the Hoover Technology Policy Accelerator Job at Stanford University

Research Assistant for the Hoover Technology Policy Accelerator**Hoover Institution, Stanford, California... ...to the advanced study of economics, politics, history, and political economy-both... ...of Arts degree in an applicable social science related field and two years applicable...

Dadeland Animal Hospital Inc

Clerical Administrative Assistant- REMOTE FT/PT Job at Dadeland Animal Hospital Inc

We are seeking a competent Clerical Administrative Assistant to support our office's daily administrative operations. The ideal candidate will be well-organized, proficient in communication, and comfortable with routine tasks. The Clerical Administrative Assistant will...

Wyndy

Babysitter for Two Boys Job at Wyndy

We are seeking a reliable and caring babysitter for our two boys, ages 8 and 2 1/2, in San Jose, CA. The position will be for one day, Monday, May 12, 2025, from 11:00 AM to 9:15 PM, with potential for additional dates a few times a month, including some weekends if available...

Four Corners

Federales Chicago - Host/Hostess Job at Four Corners

...growing!~ Medical & supplemental insurance~ Employee events and volunteer opportunities~ And more! Job Summary Host/Hostess position for a talented and dynamic individual, excited to grow in the service industry. Responsibilities and Duties Greet...

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

VVlUS3IzcU1GTlc2d283elFVeVZoODJEdXc9PQ==