Top 31 Utilization review nurse Jobs in Hopewell, Nj

Documentation Review Nurse
Hunterdon Health —Flemington, NJ
- $93,077.77 - $116,347.21 a year
- Full-time
- Nursing
- RN License
- Bachelor of Science
- Health insurance
- Dental insurance
Quick Apply
Case Manager RN - Part Time
Penn Medicine —Plainsboro, NJ
- $41.49 - $66.15 an hour
- Part-time
- Nursing
- RN License
- Mid-level
- Tuition reimbursement
Quick Apply
RN Care Manager – Program Evaluation (MED-25-00002)
Catholic Charities - Diocese of Trenton —Trenton, NJ
- $80,000 a year
- Full-time
- Bilingual
- Background check
- CPR Certification
- Health insurance
- Dental insurance
Quick Apply
MDS Coordinator/Case Manager
Skilled Nursing and Rehabilitation Center —Township of Lawrence, NJ
- Full-time
- Anatomy knowledge
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
MDS Coordinator
Hunterdon Care Center —Flemington, NJ
- $95,000 - $115,000 a year
- Full-time
- Skilled nursing facility
- Management
- RN License
- Health insurance
- Dental insurance
Quick Apply
10h
Utilization Review Supervisor - FT - Day - Utilization Resource Mgmt Trenton NJ
Capital Health —Trenton, NJ
- $86,964.80 - $119,714.81 a year
- 8 hour shift
- Nursing
- RN License
- Computer literacy
- AD&D insurance
- Disability insurance
Care Management Registered Nurse
Capital Health —Trenton, NJ
- $50.47 an hour
- 8 hour shift
- CPR Certification
- Nursing
- RN License
- Disability insurance
- Health insurance
RN Care Manager/Project Evaluator
Catholic Charities - Diocese of Trenton —Trenton, NJ
- Full-time
- Nursing
- Mid-level
Quick Apply
RN II (Field Based - Hudson County)
Horizon Blue Cross Blue Shield of New Jersey —Hopewell, NJ
- $79,100 - $105,945 a year
- Full-time
- Bilingual
- Nursing
- RN License
- Health insurance
- Dental insurance
Utilization Review RN - FT - Day - Utilization and Resource Mgmt Pennington NJ
Capital Health —Pennington, NJ
- $39.40 - $51.47 an hour
- 8 hour shift
- Nursing
- RN License
- Acute care experience
- AD&D insurance
- Disability insurance
14d
Nursing House Supervisor - Carrier Clinic - Full Time Evenings
Hackensack Meridian Health —Belle Mead, NJ
- From $113,817.60 a year
- Weekends as needed
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Utilization Management Coordinator
Rutgers University —Piscataway, NJ
- $71,162 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Dental insurance
House Supervisor - Psych Nursing - P/T with Benefits Evenings
Hackensack Meridian Health —Belle Mead, NJ
- From $88,524.80 a year
- Part-time
- Nursing
- RN License
- Inpatient
- Health insurance
- Dental insurance
Care Management Nurse
Capital Health —Trenton, NJ
- $40.20 - $53.59 an hour
- 8 hour shift
- Nursing
- Surgery
- RN License
- AD&D insurance
- Disability insurance
House Supervisor - Psych Nursing - P/T Evenings
Hackensack Meridian Health —Belle Mead, NJ
- From $88,524.80 a year
- Part-time
- Nursing
- RN License
- Inpatient
- Health insurance
- Dental insurance
Admissions Review Specialist
Avenues Recovery —Doylestown, PA
- Full-time
- Mid-level
- Master's degree
- Organizational skills
- Paid holidays
- Health insurance
Quick Apply
HomeCare Population Health Nav
Redeemer Health —Philadelphia, PA
- PRN
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
Clinical Appeals Review Nurse
Revu Healthcare —North Brunswick, NJ
- Full-time
- Remote
- Nursing
- RN License
- 5 years
Quick Apply
Appeals Professional III (Licensed Clinician)
Tanaq Support Services LLC —United States
- Full-time
- Remote
- Nursing
- RN License
- Writing skills
11d
Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- LVN
- RN License
- Mid-level
- Travel reimbursement
- Health savings account
Quick Apply

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utilization review nurse jobs near hopewell, nj

Documentation Review Nurse

Hunterdon Health -
Flemington, NJ

Quick Apply

Job Details

Full-time
$93,077.77 - $116,347.21 a year

Benefits

Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Vision insurance

Qualifications

Nursing
Medical billing and coding experience in emergency medicine
Medicare
RN License
Medicare regulations
Centers for Medicare & Medicaid Services (CMS) billing regulations
Constructive feedback for students
Nursing

Full Job Description

Documentation Review Nurse

Position Summary

The Documentation Review Nurse will apply expertise and knowledge and review clinical documentation of Emergency Department (ED) Records to ensure accuracy, completeness, and compliance with E&M Level coding and billing standards for reimbursement purposes. This position will be reviewing the E&M Level coding and documentation of nurses. The position will support data integrity and will collaborate closely with physicians, coders, and other healthcare professionals to optimize documentation practices, improve the accuracy of coding and maximize reimbursements and minimize billing denials.

Primary Position Responsibilities

Clinical Documentation Review: Assess emergency department documentation using Emergency Department E/M and Critical Care Facility Charge Assessment tool to ensure the patient documentation accurately reflects the patient’s clinical presentation, diagnoses, and captures all treatment and services provided.

Coding Compliance: Verify that documentation support CPT, E&M Level and HCPCS codes for billing and reimbursement.

Education and Feedback: Provide constructive feedback and education to ED nursing team on documentation practices to improve compliance and clarity.

Collaboration with Coders: Work closely with coding professionals to address discrepancies and clarify documentation for accurate coding.

Regulatory Compliance: Ensure all documentation aligns with regulatory requirements, payor policies, and industry standards.

Performance Metrics: Track and report on nursing documentation trends, identifying areas for improvement to enhance reimbursement and reduce denials.

Continuous Learning: Stay up to date on changes in E&M coding guidelines, payor requirements, and clinical documentation standards.

HIPAA Compliance: Maintain strict HIPAA compliance and confidentiality in reference to all information reviewed and/or discussed.

Utilize effective critical thinking skills to resolve issues and assess and implement improved methods for efficient capture of patient services in compliance with coding and documentation regulations to ensure revenue capture and reduce denials and appeals.

Work closely with 3rd party vendors, IT, and internal revenue cycle teams to resolve data quality issues

Other duties as assigned: to support the unit, department, entity and health system.

Qualifications

Minimum Education:

Required:

Registered Nurse (RN) with an active and unencumbered license

Preferred:

Bachelor of Science in Nursing (BSN) preferred

Minimum Years of Experience (Amount, Type and Variation):

Required:

Minimum of three (3) years clinical nursing experience

Preferred:

Previous nursing experience in an emergency department

License, Registry or Certification:

Required:

RN certification

Preferred:

None

Knowledge, Skills and/or Abilities:

Required:

Strong understanding of ICD-10, CPT and HCPCS coding principles
Knowledge of Medicare reimbursement and coding structures/systems

Preferred:

Experience in clinical documentation improvement (CDI), coding or utilization review is highly desirable/preferred
Excellent analytical, organizational and communication skills
Proficient in electronic health records (EHRs) and clinical documentation systems
High level creativity, judgment and initiative, tempered with flexibility to deal with rapidly changing healthcare environment and expanding technology
Ability to maintain concentration with attention to detail even in areas containing multiple levels of distraction
Self-motivated, well organized and possess confidence and ability to wor work independently and deal with ambiguity and ask critical questions to problem solve issues as required.

Hunterdon Health is committed to providing a competitive benefit package to our employees. Benefit offerings vary based on status and may include but not be limited to medical, dental, vision, family forming, paid time off, tuition reimbursement, and retirement savings

The hiring range listed is the potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement. When determining an applicant’s hourly rate and/or base salary, several factors may be considered as applicable (e.g., years of relevant experience, education, internal equity, and specialty).

Location: HHS Hunterdon Healthcare System Inc. · Health Infor Mgmt Sys
Schedule: Full-time, Day shift, M-F 8am-4:30pm

Quick Apply

Refine Your Search

utilization review nurse jobs in hopewell, nj

Documentation Review Nurse

Case Manager RN - Part Time

RN Care Manager – Program Evaluation (MED-25-00002)

MDS Coordinator/Case Manager

MDS Coordinator

Utilization Review Supervisor - FT - Day - Utilization Resource Mgmt Trenton NJ

Care Management Registered Nurse

RN Care Manager/Project Evaluator

RN II (Field Based - Hudson County)

Utilization Review RN - FT - Day - Utilization and Resource Mgmt Pennington NJ

Nursing House Supervisor - Carrier Clinic - Full Time Evenings

Utilization Management Coordinator

House Supervisor - Psych Nursing - P/T with Benefits Evenings

Care Management Nurse

House Supervisor - Psych Nursing - P/T Evenings

Admissions Review Specialist

HomeCare Population Health Nav

Clinical Appeals Review Nurse

Appeals Professional III (Licensed Clinician)

Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license

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