Utilization Management Registered Nurse

The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria, regulatory requirements, and organizational role. The UM RN ensures optimal patient care delivery while supporting compliance, quality outcomes, and effective resource utilization.

The role is responsible for the assessment of medical necessity, both for admission to the hospital as well as continued stay. This function ensures that services are not only appropriate but ensures that an authorization is obtained from the payer, if required, and that the documentation supports the care delivered in such a way that minimizes risks of denial Work requires the knowledge of theories, principles, and concepts normally acquired through completion of a Bachelor of Science in Nursing and least at least 3 years of previous nursing experience.

Preferred 3+ years of Utilization Review or Case Management experience. Case Management Society of America Certification CCM preferred. Licensure required as a Registered Nurse by the State of New Jersey.