Utilization Review RN
Trenton, New Jersey
Capital Health Regional Medical Center

Job Opportunity: Utilization Review Registered Nurse (RN)

Location: Trenton, 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 focusing on level-of-care determinations from the Emergency Department (ED gatekeeping). This role ensures patients receive appropriate care levels while supporting compliance, resource efficiency, and quality outcomes.

Required Qualifications

• Education:

  • Associate’s Degree in Nursing required (BSN preferred)
  • Graduate of an accredited nursing program

• License:

  • Current New Jersey Registered Nurse (RN) license

• Experience:

  • Minimum 5 years of clinical nursing experience
  • At least 3 years in utilization review, denial management, or quality management (able to step in with minimal training)

• Certifications (Preferred):

  • CPHQ, CCM, ACM, or CPUR

• Skills:

  • Strong knowledge of Utilization Review guidelines (MCG preferred)
  • Proficiency in Microsoft Office, EMR, and UR software
  • Effective communication and problem-solving skills for collaboration with physicians, payers, and care teams

• Prior Travel Experience:

  • Not specified / not required

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 current with CMS regulations and payer guidelines
• Participate in daily huddles, care team meetings, and performance improvement initiatives

Contract Length

• 13 weeks

Additional Requirements / Screening

• Background check
• BLS certification
• Drug screening
• Immunizations (Hepatitis B, Influenza, MMR, Varicella)
• Physical exam
• License and educational verification
• Competency exams and skills checklist
• Various compliance and ethics acknowledgements

Dress Code

• Business attire required
• Scrubs permitted only with a white scrub jacket
• Preference for business attire to avoid confusion with clinical roles outside UR responsibilities