RN Utilization Review Full-time
St. Joseph's Health

Utilization Management Registered Nurse

St. Joseph's Health Paterson, NJ 07503, US

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 denials.

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

RN Pediatric Full-time
Village MD

RN - Pediatric Dermatology

Village MD Harrison, NY
$34.01 - $42.50 / hour
About Our Company We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care. Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical , Village Medical at Home , Summit Health , CityMD , and Starling Physicians . When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care. Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com. Job Description Essential Job functions: · Assist the physician and staff with the daily coordination of patient care and physician access. · Function as the liaison between patients, staff, and physicians. · Maintains efficient patient flow. · Delivers direct patient care within the scope of licensure and in accordance with SMG policy. · Collects lab specimens according to departmental guidelines. Accurately labels specimens. · Prioritizes patient care by implementing physician orders and nursing procedures. · Ensures proper preparation for patient visit. Prepares pertinent information needed for patient visit. · Effectively communicates problems, concerns or issues to the Office Supervisor/Manager appropriately and promptly. · Assures all patients are correctly identified prior to providing and/or documenting care. · Ensures proper preparation for patient visit. Prepares pertinent information needed for patient visit. · Employs appropriate and timely use of Tasking in EHR. · Obtains vital signs: BP, temp, pulse, height & weight accurately and completely as required. Documents appropriately in EHR. · Administers injections according to appropriate protocol. Documents injections accurately in EHR. · Appropriately demonstrates telephone triage protocols and document in EHR. · Schedules appointments appropriately and accurately according to department guidelines. · Appropriately adheres to universal safety precautions when administering medications and disposal of medical waste. · Reviews and updates medication list in EHR. Demonstrates understanding of prescription control and prescription refill procedures. Accurately and completely documents known allergies in EHR. · Appropriately enters orders and schedules appointments in the Practice Management System (PMS) and EHR. · Provides referrals and/or consult orders appropriately and in a timely manner in the PMS and EHR. · Checks and maintains logs for emergency equipment according to policy. · Facilitates transition of care to UCC/Hospital. · Maintains proficiency with department specific equipment troubleshoots and reports malfunctions promptly. Education, Certification, Computer and Training Requirements: · Associates degree required. Bachelor’s degree preferred. · State Nursing License and BLS certification required upon hire. · 0 – 1 years experience. 2-4 years experience preferred. · Ability to communicate in English, both orally and in writing. · Strong interpersonal and organizational skills. · Ability to perform diverse work assignments with time limitations with a high degree of accuracy. · Ability to use problem solving, critical thinking and priority setting skills. · Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) preferred. · Experience with Standard Office Technology in a Window based environment preferred. · Experience with patient care equipment preferred. · Experience with EHR, Practice Management System and Departmental/Ancillary Systems preferred. Travel: · Ability to commute to different locations as needed. Pay Range: $33.99 - $42.50 Hourly The provided compensation range is based on industry standards and salary determinations will be made based on numerous factors including but not limited to years of experience and location of position. About Our Commitment Total Rewards at VillageMD Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan. Equal Opportunity Employer Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws. Safety Disclaimer Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/ .
RN Pediatric Full-time
Village MD

Registered Nurse - Pediatrics

Village MD Harrison, NY
$40.38 - $50.48 / hour
About Our Company We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care. Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical , Village Medical at Home , Summit Health , CityMD , and Starling Physicians . When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care. Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com. Job Description Essential Job functions: · Owning Phone Triage and Vaccine Administration for patients · Overseeing patient education · Assist the physician and staff with the daily coordination of patient care and physician access. · Function as the liaison between patients, staff, and physicians. · Maintains efficient patient flow. · Delivers direct patient care within the scope of licensure and in accordance with SMG policy. · Collects lab specimens according to departmental guidelines. Accurately labels specimens. · Prioritizes patient care by implementing physician orders and nursing procedures. · Ensures proper preparation for patient visit. Prepares pertinent information needed for patient visit. · Effectively communicates problems, concerns or issues to the Office Supervisor/Manager appropriately and promptly. · Assures all patients are correctly identified prior to providing and/or documenting care. · Employs appropriate and timely use of Tasking in EHR. · Obtains vital signs: BP, temp, pulse, height & weight accurately and completely as required. Documents appropriately in EHR. · Administers injections according to appropriate protocol. Documents injections accurately in EHR. · Appropriately demonstrates telephone triage protocols and document in EHR. · Schedules appointments appropriately and accurately according to department guidelines. · Appropriately adheres to universal safety precautions when administering medications and disposal of medical waste. · Reviews and updates medication list in EHR. Demonstrates understanding of prescription control and prescription refill procedures. Accurately and completely documents known allergies in EHR. · Appropriately enters orders and schedules appointments in the Practice Management System (PMS) and EHR. · Provides referrals and/or consult orders appropriately and in a timely manner in the PMS and EHR. · Checks and maintains logs for emergency equipment according to policy. · Facilitates transition of care to UCC/Hospital. · Maintains proficiency with department specific equipment troubleshoots and reports malfunctions promptly. Education, Certification, Computer and Training Requirements: Associates degree required. Bachelor’s degree preferred. New York State Nursing License and BLS certification required. Required to obtain Connecticut state licensure as an RN within 3 months of hire Required to provide evidence that application for Connecticut state licensure as an RN has been started within a month of hire Must maintain multi-state licensure as an RN 1 - 4 years experience preferred. Ability to communicate in English, both orally and in writing. Strong interpersonal and organizational skills. Ability to perform diverse work assignments with time limitations with a high degree of accuracy. Ability to use problem solving, critical thinking and priority setting skills. Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) preferred. Experience with Standard Office Technology in a Window based environment preferred. Experience with patient care equipment preferred. Experience with EHR, Practice Management System and Departmental/Ancillary Systems preferred. Travel: · Ability to commute to satellite offices as needed. Pay Range: $40.38 - $50.48 Hourly The provided compensation range is based on industry standards and salary determinations will be made based on numerous factors including but not limited to years of experience and location of position. About Our Commitment Total Rewards at VillageMD Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan. Equal Opportunity Employer Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws. Safety Disclaimer Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/ .
RN Full-time
Village MD

RN - Reproductive Endocrinology and Infertility

Village MD Harrison, NY
$43.61 - $54.52 / hour
About Our Company We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care. Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical , Village Medical at Home , Summit Health , CityMD , and Starling Physicians . When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care. Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com. Job Description Essential Job functions: · Assist the physician and staff with the daily coordination of patient care and physician access. · Function as the liaison between patients, staff, and physicians. · Maintains efficient patient flow. · Delivers direct patient care within the scope of licensure and in accordance with SMG policy. · Collects lab specimens according to departmental guidelines. Accurately labels specimens. · Prioritizes patient care by implementing physician orders and nursing procedures. · Ensures proper preparation for patient visit. Prepares pertinent information needed for patient visit. · Effectively communicates problems, concerns or issues to the Office Supervisor/Manager appropriately and promptly. · Assures all patients are correctly identified prior to providing and/or documenting care. · Ensures proper preparation for patient visit. Prepares pertinent information needed for patient visit. · Employs appropriate and timely use of Tasking in EHR. · Obtains vital signs: BP, temp, pulse, height & weight accurately and completely as required. Documents appropriately in EHR. · Administers injections according to appropriate protocol. Documents injections accurately in EHR. · Appropriately demonstrates telephone triage protocols and document in EHR. · Schedules appointments appropriately and accurately according to department guidelines. · Appropriately adheres to universal safety precautions when administering medications and disposal of medical waste. · Reviews and updates medication list in EHR. Demonstrates understanding of prescription control and prescription refill procedures. Accurately and completely documents known allergies in EHR. · Appropriately enters orders and schedules appointments in the Practice Management System (PMS) and EHR. · Provides referrals and/or consult orders appropriately and in a timely manner in the PMS and EHR. · Checks and maintains logs for emergency equipment according to policy. · Facilitates transition of care to UCC/Hospital. · Maintains proficiency with department specific equipment troubleshoots and reports malfunctions promptly. Education, Certification, Computer and Training Requirements: · Associates degree required. Bachelor’s degree preferred. · New York State Nursing License and BLS certifications required upon hire. · 0 – 1 years experience. 2-4 years experience preferred. · Ability to communicate in English, both orally and in writing. · Strong interpersonal and organizational skills. · Ability to perform diverse work assignments with time limitations with a high degree of accuracy. · Ability to use problem solving, critical thinking and priority setting skills. · Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) preferred. · Experience with Standard Office Technology in a Window based environment preferred. · Experience with patient care equipment preferred. · Experience with EHR, Practice Management System and Departmental/Ancillary Systems preferred. Travel: · Ability to commute to different locations as needed. Pay Range: $43.61 - $54.52 Hourly The provided compensation range is based on industry standards and salary determinations will be made based on numerous factors including but not limited to years of experience and location of position. About Our Commitment Total Rewards at VillageMD Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan. Equal Opportunity Employer Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws. Safety Disclaimer Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/ .
RN Infusion Oncology Full-time
Village MD

RN Navigator - Oncology Infusion

Village MD Harrison, NY
$87,600 - $109,600 / year
About Our Company We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care. Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical , Village Medical at Home , Summit Health , CityMD , and Starling Physicians . When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care. Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com. Job Description To serve as the primary point of contact for patients in our Oncology Department, ensuring a seamless and positive experience throughout their care journey. This role combines patient navigation with Chemotherapy teaching, coordination, offering guidance, education and support related to both surgical and non-surgical treatments. The ideal candidate will be fostering patient engagement and satisfaction while supporting the growth of the practice. RN Navigation: • Navigate care for patients and acts as a liaison between patients and medical staff, facilitating clear and timely communication. Navigates oncology patients across the continuum of care beginning with the diagnosis of cancer to survivorship, coordinating care with staff in Radiology, Surgery, Oncology, Genetic Counseling, Internal medicine and Behavioral Health, and other departments as indicated. Refers to community resources to facilitate timely diagnosis, treatment, and survivorship. • Assesses, plans, and provides patient education and counseling to cancer patients providing physical, psychological, and emotional support to patients and their family members. • Collaborates with the multi-disciplinary team to ensure continuity of care from one provider to the next. Tracks the patient closely and ensures that care is smoothly coordinated among disciplines using an established tracking system. • Serve as a dedicated resource for patients, providing personalized guidance throughout their care journey, from initial consultation to post-procedure follow-up. • Support patients by explaining medical information, addressing concerns, and advocating for their needs throughout the healthcare process. • Educate patients addressing questions and concerns with empathy and accuracy. • Coordinate appointments ensuring patients understand preparation and recovery processes. Facilitates scheduling of appointments with other Departments to ensure timely referral and transition into specialty services. • Monitor and follow up with patients to ensure compliance with care plans and optimal outcomes. • Communicates with physicians and other members of the interdisciplinary team, within Summit Health, as well as with outside providers. • Documents patient visits and communications in Athena. • Provides information on maintaining optimal health and prevention of Cancer Recurrence including instruction on the importance of regular visit to their provider for exams, clinical follow up and imaging as recommended by their provider, maintaining proper nutrition and exercise. • Covers Oncology, Non-Oncology, Chemo Infusion as requested when needed. Registered Nurse - Oncology Infusion: • Function as the liaison between patients, staff, and physicians. • Maintains efficient patient flow. • Delivers direct patient care within the scope of licensure and in accordance with SMG policy. • Collects lab specimens according to departmental guidelines. Accurately labels specimens. • Effectively communicates problems, concerns or issues to the Office Supervisor/Manager appropriately and promptly. • Assures all patients are correctly identified prior to providing and/or documenting care. • Ensures proper preparation for patient visits. Prepares pertinent information needed for patient visits. • Employs appropriate and timely use of Tasking in EHR. • Obtains vital signs: BP, temp, pulse, height & weight accurately and completely as required. Documents appropriately in EHR. • Administers injections according to appropriate protocol. Documents injections accurately in EHR. • Schedules appointments appropriately and accurately according to department guidelines. • Appropriately adheres to universal safety precautions when administering medications and disposal of medical waste. • Reviews and updates medication list in EHR. Demonstrates understanding of prescription control and prescription refill procedures. Accurately and completely documents known allergies in EHR. • Appropriately enters orders and schedules appointments in the Practice Management System (PMS) and EHR. • Provides referrals and/or consult orders appropriately and in a timely manner in the PMS and EHR. • Checks and maintains logs for emergency equipment according to policy. Education, Certification, Computer and Training Requirements: • Associates degree required. Bachelor’s degree preferred. • ACLS Certified • New York License and BLS certification required. • Oncology Nursing Society’s Chemotherapy Immunotherapy certification or equivalent hospital[1]based certification. • 0 – 1 years experience. 2-4 years experience preferred. • Ability to communicate in English, both orally and in writing. • Strong interpersonal and organizational skills. • Ability to perform diverse work assignments with time limitations with a high degree of accuracy. • Ability to use problem solving, critical thinking and priority setting skills. • Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) preferred. • Experience with Standard Office Technology in a Window based environment preferred. • Experience with patient care equipment preferred. • Experience with EHR, Practice Management System and Departmental/Ancillary Systems preferred. Travel: • Travel to satellite locations as needed, required Pay Range: $87,600.00 - $109,600.00 Annual The provided compensation range is based on industry standards and salary determinations will be made based on numerous factors including but not limited to years of experience and location of position. About Our Commitment Total Rewards at VillageMD Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan. Equal Opportunity Employer Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws. Safety Disclaimer Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/ .
RN Manager/Supervisor Full-time
Five Star Nursing

RNS / Registered Nurse Supervisor

Five Star Nursing Kensington, NY
$60 - $62 / hour
Registered Nurse Supervisor (RNS) at a Nursing Home Facility Make a Difference on Your Own Schedule and Terms! We are seeking compassionate RNSs / Registered Nurse Supervisors to work within our client's facilities to plan, implement, and document nursing care. Our Registered Nurse Supervisors rely on experience and judgment to plan and accomplish goals. Five Star believes that qualified nurses are advocates and health educators for patients, families, and communities Hourly pay rate: $60-$62 We would love to hear from you and see how we can help you advance your career in the medical field and earn money while caring for your community! As one of Five Star Nurses Registered Nurse Supervisors, you will have access to: • Flexible Scheduling! (Days, Evenings, Nights, and Weekends available!) • Paid Orientations • Competitive Weekly Pay with Direct Deposit • Paid Sick Leave in accordance with NY law. • Dedicated Office staff & 24-hour On-call Service • Positive Work Environment • Medical, dental, vision, and other insurance options available • Lucrative Referral Bonuses RNS/ Registered Nurse Supervisor Requirements • Currently holds an active RN license to work in New York. • CPR Certified (BLS or ALS accepted) • Meets all State and Federal requirements for US employment in a Nursing Facility • Strong patient assessment skills • Ability to communicate effectively • Demonstrated clinical competency • Sigma Care Experience and Additional Language Fluency are a Plus! Five Star RNSs are expected to carry out the following tasks: • Assist physicians during examinations and procedures • Perform physician approved procedures in accordance with plan of care • Perform other duties within the scope of practice of a Registered Nurse Supervisor. • Provide supervision and support to other nurse staff. We look forward to hearing from you soon. Apply today!