Utilization Review Registered Nurse
Pennington, New Jersey
Capital Health Medical Center - Hopewell

Job Opportunity: Utilization Review RN

Location: Pennington, 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 New Jersey Registered Nurse license.
• Experience:

  • 5 years of clinical nursing experience required.
  • At least 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 Utilization Review (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 for business attire to avoid confusion with clinical roles.

Contract Length

• 13 weeks

Additional Requirements

• Background check and various health screenings and verifications (e.g., BLS, drug screen, immunizations, license verification).

Prior Travel Experience

• Not specified / Not required.