Nursing Jobs in Edison, NJ
$92,289.60 - $120,577.60 / year
Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Pay Range: $92,289.60 - $120,577.60 Scheduled Weekly Hours: 40 Position Overview Responsible for clinical review, development, and submission of inpatient and outpatient clinical appeals for denied hospital claims. This role applies clinical expertise, medical record analysis, MCG clinical criteria, and payer-specific clinical policies to support medical necessity, patient status, and other clinical determinations in order to maximize appropriate reimbursement and reduce avoidable denials. MINIMUM REQUIREMENTS Education: Graduate of an accredited school of nursing required. Experience: Three years' clinical nursing experience required. Experience in utilization review, case management, clinical appeals, CDI, or denial management required. Other Credentials: AHA BLS - Healthcare Provider,Registered Nurse - NJ CPR Requirements: Requires ACLS (or must obtain within 6 months of hire date) if assigned to: Critical Care/Intermediate/Telemetry, Emergency Rooms, Pediatrics/Pediatrics Emergency Room, Labor & Delivery, Surgical Services (not to include Perioperative), Interventional Procedures, Observation. Requires NRP (or must obtain within 6 months of hire date) if assigned to: Maternity Services Requires PALS (or must obtain within 6 months of hire date) if assigned to: Emergency Rooms, Infant Follow-Up, Surgical Services (only PACU & Same Day Surgery), Pediatrics/Pediatric ED. Knowledge and Skills: Required familiarity with MCG clinical criteria for inpatient and outpatient medical necessity and patient status determinations. Required familiarity with payer-specific clinical policies, medical necessity guidelines, and appeal requirements. Strong understanding of inpatient and outpatient medical necessity and patient status criteria. Ability to analyze medical records and synthesize clinical evidence into clear, persuasive written arguments. Strong written and verbal communication skills. Ability to work collaboratively with physicians, physician advisors, CDI, UR, and non-clinical denial staff. Proficiency with hospital information systems and Microsoft Office applications. Strong written and verbal communication skills. Ability to work collaboratively with physicians, physician advisors, CDI, UR, and non-clinical denial staff Special Training: Mental, Behavioral and Emotional Abilities: Proficiency with hospital information systems and Microsoft Office applications Usual Work Day: 12 Hours Reporting Relationships Does this position formally supervise employees? No If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager. ESSENTIAL FUNCTIONS Conducts comprehensive clinical review of denied inpatient and outpatient claims using MCG criteria and payer clinical policies to determine appeal viability. Prepares written clinical appeals and rebuttals supported by medical record documentation, MCG criteria, and payer-specific policy language Collaborates with Utilization Review, Case Management, CDI, physicians, and physician advisors to support appeal development Prepares appeal packets, ensuring completeness, accuracy, and compliance with payer submission requirements and deadlines Maintains clear and concise documentation in hospital systems related to appeal actions and clinical rationale. Identifies recurring clinical denial trends related to MCG criteria application or payer policy interpretation and escalates findings to leadership. Maintains current knowledge of MCG updates, payer policy changes, and industry best practices Participates in audits, education initiatives, and process improvement activities related to clinical denials and appeals Performs other duties as assigned and adapts to changing departmental demands. PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent physical demands include: Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion , Taste or Smell Occasional physical demands include: Sitting , Climbing (e.g., stairs or ladders) Continuous physical demands include: Standing , Walking , Carry objects , Talk or Hear Lifting Floor to Waist 35 lbs. Lifting Waist Level and Above 25 lbs. Sensory Requirements include: Very Accurate 20/40, Near Vision, Very Accurate 20/40, Far Vision, Color Discrimination, Accurate Depth Perception, Accurate Hearing Anticipated Occupational Exposure Risks Include the following: Bloodborne Pathogens , Chemical , Airborne Communicable Disease , Dust/Particulate Matter This position is eligible for the following benefits: Medical Plan Prescription drug coverage & In-House Employee Pharmacy Dental Plan Vision Plan Flexible Spending Account (FSA) - Healthcare FSA - Dependent Care FSA Retirement Savings and Investment Plan Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance Supplemental Group Term Life & Accidental Death & Dismemberment Insurance Disability Benefits – Long Term Disability (LTD) Disability Benefits – Short Term Disability (STD) Employee Assistance Program Commuter Transit Commuter Parking Supplemental Life Insurance - Voluntary Life Spouse - Voluntary Life Employee - Voluntary Life Child Voluntary Legal Services Voluntary Accident, Critical Illness and Hospital Indemnity Insurance Voluntary Identity Theft Insurance Voluntary Pet Insurance Paid Time-Off Program The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria. 
$95,000 - $107,200 / year
Overview Registered Nurse - RN Case Manager - FT - Mon-Fri - Dayshift Lead with Heart. Be the Difference. Transform End-of-Life Care. Join our company, where every day is an opportunity to deliver personalized, meaningful hospice and palliative care to patients facing life-limiting illness. We support patients and their families with dignity, comfort, and love. What You'll Do as a Hospice RN / RN Case Manager: Be the primary point of contact for patients and families, guiding them through every step of their hospice journey. Deliver and document skilled, hands-on nursing care based on each patient’s individualized Plan of Care—in their home, assisted living, or wherever they call home. Perform initial and ongoing assessments to monitor patient condition and adjust care as needed. Collaborate with an interdisciplinary team—including physicians, LPNs, CNAs, social workers, chaplains, and others—to build and refine personalized care plans. Provide emotional, physical, and spiritual support not just to the patient, but to their loved ones as well—offering education, comfort, and bereavement guidance. Teach caregivers how to care for their loved one safely and confidently, offering both practical training and emotional reassurance. Communicate important updates in patient condition to the care team, ensuring timely and appropriate interventions. Maintain accurate, up-to-date clinical documentation and follow infection control and compliance standards. Support the organization's quality improvement and scheduling initiatives to ensure care is consistent, compassionate, and efficient. Help patients and families understand and navigate topics such as: Medication administration Hospice philosophy and services Symptom and pain management End-of-life processes and expectations Compensation may vary within the salary range provided based on several factors, including but not limited to a candidate's geographic location, experience, education, skills, licensure, certifications, internal equity, and department equity. Gentiva provides associates with a comprehensive Total Rewards package, of which base pay is just one component. Salary Range: Full-Time Employee Benefits Medical, Dental & Vision Wellness Program & Resources 401(k) with Company Match Paid Time Off (PTO) FMLA, ADA, and other federal and state-required leaves Short-Term & Long-Term Disability Health Savings Account (HSA) Contribution Mileage Reimbursement or Fleet Car Program Cell Phone Reimbursement (eligible roles) Short-Term Incentive (eligible roles) Tuition Reimbursement Salary Range - $95,000 - $107,200 Essential Functions Job Responsibilities Perform comprehensive patient assessments and reassessments including in-person/telephonic RN assessments/screenings and provide education to patients, family members and caregivers as appropriate. Deliver skilled nursing interventions and symptom management aligned with goals of care. Develop and update individualized plans of care including patient visit frequency to meet individual needs and risk identification. Coordinate care across interdisciplinary teams including consultation with physicians and nurse partitioners. Provide patient and caregiver education regarding disease process, self-care techniques, end-of-life care, medications, nutrition and dietary needs. Communicate change in condition, or signs and symptoms of decline to appropriate provider (e.g., NP, PCP, Hospice Physician). Support the continuity of care by recognizing and supporting home health, palliative and hospice referrals as appropriate and recognizing and supporting transitions in levels of care. Document timely clinical records on all patients including screening/assessment findings, physician orders, progress notes, and care plans. Maintain effective working relationships with IDG, and involve team when patient's care plan warrants team participation to achieve desired outcome. Participate in on-call and patient support activities as applicable, conducting on-call services in a clinically competent and responsive manner. Core Competencies Clinical excellence and sound judgment Patient-centered communication and empathy Interdisciplinary collaboration Accountability and regulatory compliance Adaptability and critical thinking Timeliness of patient visits and documentation Accuracy and completeness of clinical records Patient and caregiver satisfaction Compliance with regulatory and policy standards Participation in team collaboration and IDG activities About You To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Education: Registered Nurse Experience: A minimum of one (1) year experience as an RN, either in acute care hospital, oncology, long-term care, hospice or home health. School internships and clinical hours may be considered as experience in individual cases. Hospice or palliative care experience preferred Licenses, Certifications and/or Registration: Current license to practice nursing in the state of requested employment CPR Certification Current automobile insurance and valid driver’s license Specialized Knowledge and Skills: Knowledge of terminally ill patients and their families along with understanding of hospice; ability to apply knowledge of the special needs of hospice patient and families; knowledge of roles of all disciplines providing hospice services; excellent patient assessment skills; knowledge of community resources; good oral and written communication skills; documentation and program management; knowledge of general nursing practice; thorough knowledge of managed care principles, regulatory guidelines (i.e., Medicare, Medicaid, ACHC, and human resource management principles). Working Conditions: Patient’s homes and/or institutional setting and automobile. Potential exposure to infections, communicable diseases, odors, blood, excreta and hazardous materials. Personal Traits, Qualities and Aptitudes: Sensitivity to the impact of life and death issues faced by individuals with terminal illness; tact in dealing with these patients and their families; ability to support others at a time of crisis. Must be able to demonstrate flexibility by performing a variety of tasks, often changing from one to another of a different nature without loss of efficiency or composure. Communicate effectively with people of all socioeconomic backgrounds. Responsible functioning in the work place, maturity, cooperation, flexibility, tact in dealing with co-workers and all members of the hospice team. Equipment/Tools/Work-Aids: Must be able to effectively operate nursing assessment tools, computers, facsimile equipment, copier and cell phone/beeper. Must have and maintain transportation to be used for work. We Offer Benefits for All Associates (Full-Time, Part-Time & Per Diem): Competitive Pay 401(k) with Company Match Career Advancement Opportunities National & Local Recognition Programs Teammate Assistance Fund Additional Full-Time Benefits: Medical, Dental, Vision Insurance Mileage Reimbursement or Fleet Vehicle Program Generous Paid Time Off + 7 Paid Holidays Wellness Programs (Telemedicine, Diabetes Management, Joint & Spine Concierge Care) Education Support & Tuition Assistance (ASN to BSN, BSN to MSN) Free Continuing Education Units (CEUs) Company-paid Life & Long-Term Disability Insurance Voluntary Benefits (Pet, Critical Illness, Accident, LTC) Ready to Join a Team That Cares? Apply now to become part of our Hospice Nursing team and help make every moment count for our patients and their loved ones. Legalese This is a safety-sensitive position Employee must meet minimum requirements to be eligible for benefits Where applicable, employee must meet state specific requirements We are proud to be an EEO employer We maintain a drug-free workplace ReqID: 2026-143757 Category: Registered Nurses Position Type: Full-Time Company: Gentiva Hospice 
