Nursing Jobs in Piscataway, 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. 
Certified Home Health Aide needed for a female client in Colts Neck Monday to Sunday 8am-12pm. Assisting with usual ADL's Experience the SYNERGY HomeCare difference, where we are united under one purpose, to bring wholehearted, life-energizing care to as many people as possible - on their own terms, in their own homes. And that starts with compassionate Home Health Aides like YOU! When you join the SYNERGY HomeCare team as an HHA, you will feel appreciated, recognized, and rewarded for the comforting, life-affirming care that comes right from your heart! Our promise to our clients is to bring full support for fuller lives and to elevate their confidence knowing they have a Home Health Aide like you by their side. Do you: Enjoy serving others? Have a big heart with a lot of love to share? Take charge with a warm smile? If you would like to join our outstanding team at SYNERGY HomeCare, apply today! $115,000 - $125,000 / year
Job Description Balance Life & Work with a New Career Opportunity at Care One at East Brunswick! Now Hiring – Infection Control Nurse – East Brunswick, NJ Salary Range: $115,000.00- $125,000.00 per year CareOne at East Brunswick SNF The primary purpose of the Infection Control Nurse is to plan, organize, develop, coordinate, and direct our infection control program and its activities in accordance with current federal, state, and local standards, guidelines, and regulations that govern such programs, and as may be directed by the Administrator and the Infection Control Committee to ensure that an effective infection control program is maintained at all times. Ensure that the facility is in compliance with current CDC, OSHA, and local regulations concerning infection control or standard/universal precautions. Develop, maintain, and periodically update infection control precautions and aseptic technique that successfully correct problem areas. Interpret infection control policies and procedures as necessary. Monitor infection control practices and procedures to ensure that all personnel are implementing our standard operating procedures for tasks involving exposure to blood/body fluids. Make rounds to nursing units for the purpose of case findings, review of environmental sanitation procedures, and supervisions of isolation precautions/practice. Visit isolated residents as necessary to ensure that established isolation precautions and aseptic technique are followed. Provide direct nursing care as necessary. Education Must possess, as a minimum, a nursing degree from an accredited school of nursing. Experience Must have, as a minimum, two (2) years clinical experience in a hospital, nursing care facility or other related healthcare facility. Must have, as a minimum, six (6) months training experience in rehabilitative and restorative nursing practices. Must possess as working knowledge of epidemiology, microbiology, infectious diseases, and aseptic technique to include standard/universal precautions. APIC Certification in infection control preferred, but not necessary. About Us The CareOne mission is to define excellence within the health care community. We are dedicated to Maximizing Patient Outcomes. We treat Residents, their families and each other with respect, dignity and compassion. Through a collaborative and consultative approach, we strive to provide a framework of strength and stability for our Centers and Communities. We work to maintain the highest standards of care and service for Residents, families and our valued employees. We are proud to Offer the following benefits to Part-time (22.5+ hours/week) and Full-time Employees: Comprehensive Healthcare Benefits Multiple Medical Plans Including Pharmacy Including Teladoc Multiple Dental Plans Vision Plan Health Savings Account (eligibility restrictions apply) Flexible Spending Accounts Voluntary Life and AD&D Short-Term and Long-Term Disability Plans Hospital Indemnity Insurance Critical Illness Insurance Accident Insurance Whole Life Insurance Medicare Employee Assistance Legal Plan Commuter Benefits 401k Retirement Plan Employee Assistance Program (available to all employees) Paid Time Off Vacation Sick Plans in accordance with state laws Opportunities to advance and grow your career If working with people who are dedicated, compassionate, and concerned about their patients is essential to you, then you'll appreciate being a part of our team. We've built a strong reputation on the outstanding level of care that we provide. We have a graciously appointed facility with strong belief in patient care and service; join us at our beautiful facility! We are an Equal Opportunity Employer EEO/AA/M/F/DV 
