Travel Nurse RN - Case Management
Trenton, NJ
GHR Healthcare
3x12 hrs, Days

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.