Travel Nurse RN - Case Management
Pennington, NJ
TalentBurst, Inc
3x12 hrs

Registered Nurse - Case Manager
Pennington, NJ

Guaranteed Hour: 36
Time Type: 8:00am-8:30pm (8:00 AM - 8:30 PM)

Additional Information
Job Title: Utilization Review RN
Location: Onsite – New Jersey
Schedule: 12-hour shifts (7:30am–8:00pm or 8:00am–8:30pm)
Every 3rd weekend required
1 holiday per season
Position Summary
The Utilization Review RN conducts concurrent reviews with a strong focus on level-of-care determinations from the Emergency Department (ED gatekeeping). This role ensures patients receive appropriate levels of care while supporting compliance, resource efficiency, and quality outcomes.
Minimum Requirements
Education: Associate's Degree in Nursing (BSN preferred). Graduate of an accredited nursing program.
License: Current NJ Registered Nurse license.
Experience:
5 years of clinical nursing experience.
At least 2–3 years in utilization review, denial management, or quality management (must be able to step in with minimal training).
Certifications (Preferred): CPHQ, CCM, ACM, or CPUR.
Skills:
Strong knowledge of UR guidelines (MCG preferred).
Proficiency in Microsoft Office, EMR, and UR software.
Effective communication and problem-solving skills for working with physicians, payers, and care teams.
Key Responsibilities
Conduct concurrent review of patient charts.
Communicate with payers regarding admissions, continued stay, and denials.
Document utilization activities, barriers, and care progression.
Identify strategies to reduce avoidable days and unnecessary resource use.
Collaborate with physicians, case managers, and other stakeholders to ensure proper utilization.
Stay up to date with CMS regulations and payer guidelines.
Participate in daily huddles, care team meetings, and performance improvement initiatives.
Dress Code
Business attire is required.
Scrubs are permitted only when worn with a white scrub jacket.
Preference is for business attire, as wearing scrubs may confuse patients and lead to requests for clinical tasks outside the UR role.

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