Clinical Review RN PRN
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Cooper University Hospital
Camden, NJ, US
Summary
The role involves performing utilization reviews and determining medical necessity using payer-specific screening tools. The RN will manage denials and coordinate with physicians and payers to ensure appropriate levels of care.
Job Description
About Us
At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development.
Discover why Cooper University Health Care is the employer of choice in South Jersey.
Short Description
- Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity. Performs utilization review in accordance with all state mandated regulations.
- Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues.
- Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers.
- Completes documentation of review and denial processes in the EPIC Case Management Module. Responds to requests from the payer for all required information and treatment plans.
- Reviews and validates physician’s orders, reports progress and unusual occurrences on patients to the payer.
Experience Required
3-5 years of recent clinical experience, preferably in area of population specialty.
Experience in utilization management or review preferred.
Knowledge and understanding of disease protocols and clinical pathways for commercial and government payors. Familiarity with Interqual and Millimen guidelines and regulatory mandates preferred.
Strong communication (written and verbal) and critical thinking skills required. Professional and effective presentation skills required.
Education Requirements
Bachelor’s degree in Nursing preferred
License/Certification Requirements
Current NJ-RN License required.
Special Requirements
Monday availability is required.
Salary Min ($)
USD $37.00
Salary Max ($)
USD $61.00
Cooper University Health Care is the leading academic health system in South Jersey and provides access to primary, specialty, tertiary, and urgent care, all within one complete health system. Cooper has nearly 14,000 team members including 1,600 nurses, more than 1,000 employed physicians representing 95 specialties and subspecialties, and more than 600 advanced practice professionals. Hospitals throughout the region send their most complex and critically ill and injured to Cooper for treatment by our highly skilled experts.
Ranked year after year by U.S. News & World Report as one of the top health systems in the Philadelphia Metro area, Cooper is consistently recognized for its quality, safety, and exceptional patient care.
Cooper has three hospitals: South Jersey’s only Level I trauma center, Cooper University Hospital in Camden, which is the busiest trauma center in the Philadelphia region; Cooper University Hospital Cape Regional in Cape May Court House, and Children’s Regional Hospital at Cooper, which is the only Level II pediatric trauma center in the Delaware Valley. Cooper is also home to a leading cancer center (MD Anderson Cancer Center at Cooper), six urgent care centers, and more than 130 outpatient offices from the Delaware River to the Jersey Shore, including large regional hubs in Camden, Cherry Hill, Moorestown, Voorhees, Willingboro, and Sewell.
Cooper University Health Care is affiliated with – and its physicians make up the faculty of – Cooper Medical School of Rowan University, which is located on the Cooper Health Sciences Campus in Camden, New Jersey. Cooper has a long history in the City of Camden and is playing a leading role in its revitalization.
Founded
1887
Company size
10,001+ employees
Industry
Healthcare
Org type
Nonprofit
Headquarters
Camden, NJ
Cooper University Health Care is the leading academic health system in South Jersey and provides access to primary, specialty, tertiary, and urgent care, all within one complete health system. Cooper has nearly 14,000 team members including 1,600 nurses, more than 1,000 employed physicians representing 95 specialties and subspecialties, and more than 600 advanced practice professionals. Hospitals throughout the region send their most complex and critically ill and injured to Cooper for treatment by our highly skilled experts.
Ranked year after year by U.S. News & World Report as one of the top health systems in the Philadelphia Metro area, Cooper is consistently recognized for its quality, safety, and exceptional patient care.
Cooper has three hospitals: South Jersey’s only Level I trauma center, Cooper University Hospital in Camden, which is the busiest trauma center in the Philadelphia region; Cooper University Hospital Cape Regional in Cape May Court House, and Children’s Regional Hospital at Cooper, which is the only Level II pediatric trauma center in the Delaware Valley. Cooper is also home to a leading cancer center (MD Anderson Cancer Center at Cooper), six urgent care centers, and more than 130 outpatient offices from the Delaware River to the Jersey Shore, including large regional hubs in Camden, Cherry Hill, Moorestown, Voorhees, Willingboro, and Sewell.
Cooper University Health Care is affiliated with – and its physicians make up the faculty of – Cooper Medical School of Rowan University, which is located on the Cooper Health Sciences Campus in Camden, New Jersey. Cooper has a long history in the City of Camden and is playing a leading role in its revitalization.
Founded
1887
Company size
10,001+ employees
Industry
Healthcare
Org type
Nonprofit
Headquarters
Camden, NJ
