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. 
$105,000 - $110,000 / year
Field RN- CHHA Located in Westchester County, NY An amazing certified healthcare agency located in Westchester County, NY is seeking experienced Field RN to join their team. Responsibilities of the Field RN: Performs a home care assessment to determine patient’s eligibility for services. If not eligible/appropriate for home care services COC will indicate not admitted in the system and reason for the determination. If appropriate for home care services, the COC will complete a comprehensive assessment utilizing HCHB. In conjunction with patient’s family and physician, develops and implements the Plan of Care based upon a comprehensive physical, psycho-social and environmental assessment. Provides skilled nursing care as described in the 485-Plan of Treatment, such as, but not limited to, wound care, injections, prepour/prefill of medications, disease management, medication management, etc.. Orients and supervises home health aide personnel in accordance with regulatory requirements and documents accordingly. Evaluates the effectiveness of interventions in accordance with the plan of care. Identifies the need for evaluation by other disciplines such as physical therapy, occupational therapy, MSW, speech therapy and nutrition. Observes signs and symptoms and changes in patient’s clinical, psychological and functional status. Consults with physician regarding changes in the treatment plan. Educates, counsels, supervises patients and caregiver relating to disease management and medical regime. Documents in HCHB Clinical Software all assessments, treatments and services provided and patient response to the treatment plan. Case manages respective caseload which includes, but is not limited to, ongoing communication with MD, case conferencing with supervisor, obtaining updates from interdisciplinary team, completion of interim orders, updating of patient profile, conducting recertification assessments, etc. Contacts physician to report, clarify and/or obtain orders for; medication changes/additions, precautions, treatment, changes in visit frequencies, additional services needed, requests for supplies and equipment, plans for discharge from a service or the agency. Qualifications of the Field RN: Must be a graduate of an approved school of professional nursing Must have a current RN license in New York Home care experience preferred Excellent verbal and written communication skills Must be willing to drive Hudson View Network is a medical recruiting firm whose goal is to bridge exceptional talent to superior institutions. We work with various healthcare organizations to help fill needs within their facilities. #7703 
Caring Angels Home Care is looking for a Weekend Geriatric Float Nurse for our Home Care patients in the five Boroughs. Our agency has won numerous awards for staff satisfaction and patient care excellence. As a float Nurse, you will play an integral role in the agency's nursing care division . Chauffeur Service is offered. Only 10 points on Friday and 10 points on Saturday! Our agency has won numerous awards for employee satisfaction and patient care. Field Nurse Duties: Must have accredited NY Registered Nurse License. Cases conveniently clustered Job Type: Full-time License/Certification: New York State Registered Nurse License (Required) Work Location: In person 
