What are the responsibilities and job description for the Utilization Management RN position at Thomas Jefferson University & Jefferson Health?
Job Details
We're hiring a full-time Utilization Management RN in New Jersey! In this role, you'll apply medical necessity criteria to review inpatient admissions, manage denials and appeals, and collaborate with case managers and physicians to ensure efficient, high-quality patient care. Ideal candidates have a BSN, RN licensure, and 3-5 years of experience in case management or utilization review. Join a supportive team where your clinical expertise drives better outcomes every day!Job Description
Utilization Management RN - Join Our Team!
Are you a skilled RN with a passion for ensuring high-quality, cost-effective care? We're looking for a Utilization Management RN to join our dynamic Case Management team!
What You'll Do:
- Apply medical necessity criteria (InterQual/MCG) to assess inpatient admissions
- Collaborate with physicians and case managers to optimize patient care
- Manage denials and appeals with precision and professionalism
- Support discharge planning and barrier resolution when needed
What You Bring:
- RN license (state of NJ)
- BSN required
- 3-5 years' experience in case management, discharge planning, or utilization review
- Strong communication and critical thinking skills
- InterQual certification preferred
Why You'll Love It Here:
- Supportive team culture
- Impactful work that improves patient outcomes
- Opportunities for growth and collaboration
- Hybrid work model; must travel to New Jersey & Pennsylvania
Be a key player in shaping care decisions and improving patient journeys. Apply today!
Work Shift
Workday Day (United States of America)Worker Sub Type
RegularPrimary Location Address
125-37 South 9th Street, Philadelphia, Pennsylvania, United States of AmericaNationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.
As an employer, the Jefferson Enterprise maintains a commitment to provide equal access to employment. Jefferson values diversity and encourages applications from women, members of minority groups, LGBTQ individuals, disabled individuals, and veterans.
