Nursing Jobs in Rockaway, NJ
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. 
Responsible for the coordination and implementation of systems and services leading towards an organized, multidisciplinary team approach to patient care management. Provides clear communication across the continuum to improve patient outcomes. Assures quality, cost-efficient care for an identified patient population through the continuum of care. Develops and coordinates efforts to reduce clinical resource utilization by working closely with physicians, nursing staff and other hospital personnel. Reviews medical records for appropriateness of admissions, continued stay and level of care changes against criteria of severity of illness and illness of service to ensure optimal reimbursement to the hospital. 
Responsible for utilizing the Nursing Process in a collaborative manner to plan, implement and evaluate nursing care in accordance with his/her scope of practice. The RN supports the goals and philosophy of the Department of Nursing within the St. Joseph's Healthcare System and on his/her assigned unit. 
$90,000 - $151,000 / year
About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for our managers. The curriculum will cover onboarding, essential functions, leading your business, and advanced leadership. As a Clinical Manager, you may advance your career into an Area Team Lead or Director of Operations role. Our culture: We believe our employees are our most important asset — we value, care about, and support our people. We are there when you may need us most, from tuition reimbursement to support your education goals, granting scholarships to family members, delivering relief when natural disasters strike, or providing financial support when personal hardship hits, we take care of our people. Our focus on diversity: We have built a nurturing environment that welcomes every age, race, gender, sexual orientation, background, and cultural tradition. We have a diverse range of employee resource groups (ERGs) to encourage employees with similar interests, goals, social and cultural backgrounds, or experiences to come together for professional and personal development, discussion, activities, and peer support. Our diverse workforce and culture encourage opportunity, equity, and inclusion for all, which is a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in the lives of people living with kidney disease. If this sounds like the career and company you have been looking for, and you want to be a vital part of the future of healthcare, apply today. PRINCIPAL RESPONSIBILITIES AND DUTIES CLINIC OPERATIONS: Manages the operations of the clinic, including costs, processes, staffing, and quality standards. Provides leadership, coaching, and development plans for all direct reports. Partners with internal Human Resources, Quality, and Technical Services departments. Collaborates with or functions as the Home Therapies Program Manager to oversee the facility’s Home Therapies Program. Maintains integrity of medical and operations records and complies with all data collections and auditing activities. Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. Responsible for all required network reporting and on-site state or federal surveys. PATIENT CARE: Coordinates all aspects of patient care with the appropriate staff members, from admission through discharge of the patient. Ensure education of the patient regarding quality measures, transplant options, modality awareness, and access care. Acts as a resource for the patient and family to address concerns and questions. Accountable for timely completion of patient care assessments and care plans. Manages timely patient schedules to ensure facility efficiency and develops action plans for missed treatments. Plans, coordinates, and validates patient eligibility for treatment. Reports changes in patient status regarding any clinical, insurance, or travel and transportation issues. STAFF: Participates in the selection and hiring of new team members and ensures completion of new hiring orientation and mandatory trainings. Responsible for all patient care employees completing appropriate training courses and that licensures/certifications are current. Provides support for all clinical staff members at regular intervals and encourages professional growth. Maintains current knowledge regarding company benefits, policies, procedures, and processes. Completes employee evaluations and establishes annual goals. Documents any disciplinary actions and confers with the clinic Director of Operations and Human Resources when needed. Manages staff scheduling and payroll. PHYSICIANS: Facilitates the application process for physician privileges and compliance with Fresenius Medical Care Medical Staff By-Laws. Responsible for strong physician relationships and ensures regular and effective communication. Participates in Governing Body, an interdisciplinary team for each region including MSWs, Dietitians, MDs, DOs etc. that governs policies. EDUCATION AND REQUIRED CREDENTIALS: Bachelor’s Degree or an equivalent combination of education and experience. Graduate of an accredited School of Nursing (RN). Current appropriate state licensure. EXPERIENCE AND SKILLS: Required: 6+ years business operations experience in a healthcare facility. 12 months experience in clinical nursing. 6 months chronic or acute dialysis nursing experience. Successfully pass the Ishihara Color Blind Test. Preferred but not required: 3+ years supervisory or project/program management experience. Med/surg or ICU/CCU experience. PHYSICAL DEMANDS AND WORKING CONDITIONS: Day-to-day work includes desk and personal computer work and interaction with patients, facility staff, and physicians Position may require travel between assigned facilities and various locations within the community and/or travel to regional, business unit, and corporate meetings may be required. The work environment is characteristic of a healthcare facility with air temperature control and moderate noise levels. May be exposed to infectious and contagious diseases/materials. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The position provides direct patient care that regularly involves heavy lifting, moving of patients, and assisting with ambulation. Equipment aids and/or coworkers may provide assistance. The rate of pay for this position will depend on the successful candidate’s work location and qualifications, including relevant education, work experience, skills, and competencies. Annual Rate: $90,000.00 - $151,000.00 Non-Bonus Eligible Positions: include language below. Benefit Overview: This position offers a comprehensive benefits package including medical, dental, and vision insurance, a 401(k) with company match, paid time off, parental leave. Bonus Eligible Positions – include language below. Benefit Overview: This position offers a comprehensive benefits package including medical, dental, and vision insurance, a 401(k) with company match, paid time off, parental leave and potential for performance-based bonuses depending on company and individual performance. Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws. Fresenius Medical Care is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sexual orientation, gender identity, parental status, national origin, age, disability, military service, or other non-merit-based factors 
