RN jobs in Millstone Township, NJ

RN Jobs in Millstone Township, NJ

Clinical Appeals RN - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville 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.

Manager/Supervisor

Part-time

2 months ago

Unit Manager/RN Supervisor

CareOne Wall Township, NJ

$100,000 - $115,000 / year

Job Description Balance Life & Work with a New Career Opportunity (LONG TERM CARE) (SHORT TERM REHAB) (SKILLED NURSING) Now Hiring - Unit Manager - Wall, NJ Salary range $100,000 - $115,000 / per year CareOne at Wall Job Duties The Unit Manager is responsible for the day to day coordination oversight of all aspects of his/her assigned clinical unit. Job duties include, but are not limited to: Ensure that required staffing levels are met for each shift on a daily basis needed to render care for the number of residents assigned to her/his responsibility. Make sure that staffing level adjustments are made each shift as needed and the Federal required posted schedule is adjusted to reflect current actual staffing. Attend, participate and lead the weekly resident "At Risk" meeting ensures resident care and condition concerns are identified, interventions are appropriate to cause and follow up is completed. Attend and participate in morning clinical review meeting. Attend and participate in PPS meetings as indicated. Attend and participate in monthly QA and A meetings, as assigned, and assist with follow up for any identified problems. Monitor provision of resident care by licensed nurses and C.N.A.'s ensure required documentation is completed. Review 24- hour resident change in condition report daily ensure necessary follow-up occurs including appropriate interventions implemented, physician and family notified and required documentation has been completed. Review resident medical records and documentation to ensure clinical programs are in place per policy and procedures. Identify educational needs of staff discuss findings with the Facility Educator and work collaboratively to meet these needs. Participate on other committees as requested by the Administrator/Director of Nursing Services. Ensure that resident care and documentation is in compliance with state and federal rules and regulations. Comply with and ensure that staff is in compliance with HIPAA rules and regulations, reporting any known violations to the Administrator and Director of Nursing Services. Ensure work assignments are made for assigned staff, including breaks and lunches and staff is compliant with assignments. Initiate disciplinary action as necessary for staff members in collaboration with DON/ADON. Communicate with the appropriate department manager/DON and participate with follow up and resolution to any grievances/concerns from personnel, residents or family members. Ensure physician orders are being followed. Assist the DON/ADON with preparing performance evaluations as directed. Greet new admissions and families and assist nursing staff with admission process as needed. Within 24 to 48 hours, ensure that all admission documentation is complete including all required clinical assessments and care plans. Monitor medication passes and treatment schedules to ensure that medications are being administered as ordered and that treatments are provided as scheduled. Provide direct nursing care as necessary. Report problem areas to the Director of Nursing. Assist in developing and implementing corrective action. Attend and participate in continuing education programs to remain current with standards of nursing practice and to maintain licensure requirements. Ensure that your nursing staff follows policy and procedures, including appropriate dress code. Ensure that nursing staff participate in all fire safety and disaster preparedness drills. Ensure that nursing personnel are follow established infection control procedures when isolation precautions become necessary. Ensure that all personnel operate nursing equipment in a safe manner. Participate as needed and/or directed in collaboration with the Resident Assessment/Care Plan Coordinator in the development of a written care plan (preliminary, interim and comprehensive for each resident that identifies the problems/needs of the resident, indicates the care to be given, goals to be accomplished and which professional service is responsible for each element of care. Ensure that all nursing care is provided in privacy and that nursing service personnel knock before entering the resident's room. Report and assist with investigation of any allegations of resident abuse including misappropriation of resident property. Assist Social Services with ensuring that an Advance Directive/Code Status has been obtained and documented in appropriate places per policy. Participate in the annual survey and/or complaint survey processes as directed by Administrator/DON and assist as directed with any plans of correction required. Position Requirements Bachelor's degree preferred and/or must be a graduate of an approved RN program. Must be an actively licensed RN in assigned state(s) of employment Previous supervisory experience. Two years of LTC experience. Acute Care experience preferred. 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

PACU

Part-time

2 months ago

RN Certified - Recovery Room PRN T2

Jupiter Medical Center Neptune Township, NJ

Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast. Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS). Education: Graduate of an accredited school of professional nursing, BSN preferred. Experience / Qualifications: Clear and Active RN licensure in the State of Florida, American Heart Association BLS certification for Healthcare Providers, American Heart Association ACLS certification, NIHSS Certification, CCRN Preferred, At least 2 years of ICU experience Position Summary Within nursing services, the Registered Nurse assumes the accountability and responsibility as a professional nurse for providing “Patient Centered Care” for an assigned group of patients. The RN plans, directs, and evaluates nursing care while providing a holistic view, which may include dimensions of physical, developmental, emotional, psychosocial, cultural, spiritual, and functional status. Assessment involves the orderly collection of information to develop a comprehensive Standard of Care to meet identified patient care outcomes and evaluate effectiveness of a nursing plan of care. Established nursing objectives, standards, policies, and procedures will be followed in administering nursing care. Initial assessments provide a baseline for future comparisons that can be made in order to individualize care. Ongoing assessment and reassessment are required to meet the patient’s changing needs. RN ensures accurate documentation, adequate supplies and is knowledgeable in operation of equipment. The RN has a responsibility to act as educator to their peers, patients, and their families. All aspects of the RN’s performance supports service excellence and a healing environment. Performs other duties as assigned. Team Member Competencies Establishing Relationships Builds effective networks, working relationships, and alliances in order to collaborate effectively within department and organization. Can relate to all kinds of people regardless of background; find topics and common interests that can be used to build rapport with others. Peer Support Provides guidance and feedback to help others strengthen knowledge/skills needed to accomplish tasks, solve problems, and perform effectively within the team. Inspiring and Motivating Others Fosters commitment and cohesiveness by facilitating cooperation and working as a team within the organization toward goal accomplishments. Works well with others, builds consensus, and ensures cooperation to complete tasks and positive workflow. Demonstrating Emotional Intelligence Exercises self-leadership, self-awareness, and self-regulation; manages emotions so that they are expressed appropriately; leads others by showcasing adaptability, empathy, and social skills. Acting with Integrity Interacts with others in a way that is seen as direct and truthful; ensures confidence in individual and organizational motives and representations. Acts in a way that is consistent with personal and organizational values by keeping confidence, promises, and commitments. Clearly states goals and beliefs; informs people of their true intentions, does what they say they will do; follows through on commitments. Being a Champion for Change and Innovation Supports people in their efforts to try new things. Things creatively, generates novel and valuable ideas and uses these ideas to develop new or improved processes. Accepts new ways of doing things and adapts to change. Communicating Effectively Speaks and writes clearly, conveys information in a concise, organized, and logical manner. Is adept at tailoring the message to fit the interests and needs of the audience. Listens attentively and exercises tact, discretion, and diplomacy when interacting with members of the department and organization. Promoting Diversity and Inclusion Treats all people with dignity and respect. Demonstrates an open-minded approach to understanding people regardless of their gender, age, race, national origin, religion, ethnicity, disability status, or other characteristics. Challenges bias and intolerance. Develops all-inclusive groups in the realms of social interaction and communication. Shows respect for the beliefs of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds. Physical Requirement Hand and Wrist (Test both left and right sides). Grip a dynamometer for 10 seconds with a force > 10 lbs. Pinch together the thumb & forefinger for 10 seconds with a force > 2 lbs. Supported Elbows (Test both left and right sides. Rotate wrist from left to right while holding 10 lb. weight. Fully flex and extend elbow while holding a 10 lb. weight. Shoulders (Test both left and right sides). Sustain shoulder flexion > 135 degrees while holding 10 lb. weight. Sustain a shoulder shrug while holding 10 lb. weight in each hand. Legs. Squat and hold position for 30 seconds. Kneel on a single knee, demonstrated on either left or right knee. Push and Pull. Push a stationary loaded cart with a pushing force of 40 lbs. Pull a stationary loaded cart with a pulling force of 40 lbs. Carrying. Carry a 20 lb. weight for a distance of 25 feet. Lifting. Weight lifted during lift test (35lbs. Female - 50lbs. Male requirement). Floor to Table. Waist to above shoulder height (20 lbs. requirement). Threshold Requirements These threshold requirements are required and completed yearly basis. Annual Joint Commission mandatory education requirements, in-service and health requirements including attendance at new employee orientation, TB/PPD Surveillance Program, and maintenance of required professional licensing and/or certification(s).