Utilization Reviewer; RN

Utilization Reviewer (RN)- Full Time, Days, 8 AM - 4 PM, Morristown

Morristown, NJ, United States

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• 1.Provides timely and thorough clinical information to insurance companies and other intermediaries to secure payer authorizations and avoid denials or reduction in level of care.
• 2.Performs daily surveillance of observation cases and works with PA discussing any barriers to progression of care or discharge.
• 3.Intervenes proactively to avoid denials or delays in authorization.
• 4.Actively communicates information to other CM team members and interdisciplinary teams regarding progress or payer issues related to continued hospitalization and post-acute service associated with the patients discharge plan.
• 5.Refers cases and issues to Physician Advisors or Designees in compliance with department procedures with timely follow up as indicated
• 6.Assists in identification and collection of avoidable days
• 7.Coordinates with the CM RN and/or CMA to identify and complete the process for CMS required patient notices.
• 8.Completes and documents utilization reviews, physician advisor referrals and other communications related to assigned cases in accordance with department policy and procedure.
• 9.Complies with the Condition of Code 44 process, CMS required patient notices and other regulatory requirements within the utilization management process.
• 10.Maintains proficiency in the application of organization selected clinical review criteria sets evidenced through IRR testing

Graduate of an accredited school of nursing - required

BSN - preferred

Current RN license - required

Case Management
- Preferred

At Atlantic Health, our promise to our communities is;
Anyone who enters one of our facilities will receive the highest quality care delivered at the right time, at the right place, and at the right cost. This commitment is also echoed in the respect, development and opportunities we give to our more than 22,000 team members. Headquarters in Morristown, New Jersey, we are one of the leading non-profit health care systems in the nation.

Our facilities and sites of care include:

• Atlantic Health Morristown Medical Center, Morristown, NJ
• Atlantic Health Overlook Medical Center, Summit, NJ
• Atlantic Health Newton Medical Center, Newton, NJ
• Atlantic Health Chilton Medical Center, Pompton Plains, NJ
• Atlantic Health Hackettstown Medical Center, Hackettstown, NJ
• Atlantic Health Goryeb Children's Hospital, Morristown, NJ
• Atlantic Health Centra State Healthcare System, Freehold, NJ
• Atlantic Medical Group
• Atlantic Visiting Nurse
• Atlantic Mobile Health
• Atlantic Rehabilitation

We have more than 900 community-based healthcare providers affiliated through Atlantic Medical Group.

We have received awards and recognition forthe services we have provided to our patients, team members and communities. Below are just a few of our accolades:

• Chosen for 17years by Fortune as one of the magazine’s“100 Best Companies to Work For."
• Atlantic Health Morristown and Atlantic Health Overlook Named by Newsweek as two of the“World’s Best Hospitals"in 2026.
• Atlantic Health Morristown and Atlantic Health Overlook ranked within the top three hospitals in New Jersey by U.S. News & World Report’s  Best Hospital rankings.
• Atlantic Health scored four“A”grades by The Leapfrog Group in its Fall 2025 Hospital Safety Grades, performance measures reflecting errors, accidents,injuries and injections, as well as systems hospitals have in place to prevent harm.
• Atlantic Health Morristown and Atlantic Health Overlook are New Jersey's only hospitals to be named among America's 50 Best hospitals by Health grades in 2026.
• Namedby Becker's Healthcare as one of the "165 Top Places to Work in Healthcare – 2026.
• Atlantic Health Morristown, Atlantic…