Clinical Nurse Utilization Specialist

Job Summary

The Valley Health System seeks a skilled Clinical Nurse Utilization Specialist to join our team. In this part-time day role, you will be responsible for performing concurrent utilization review activities on all patients within your assigned caseload.

Collaborating with medical staff is essential in educating them on appropriate utilization review guidelines and documentation in accordance with CMS regulations and Commercial payors guidelines. Your expertise will also involve monitoring and intervening on LOS, resource utilization, and denial management/prevention within your assigned caseload.

We require a Bachelor's degree (BSN) in nursing and a minimum of 5 years of experience in clinical nursing, with at least 3 years in case management/utilization. Strong critical thinking, clinical reasoning skills, and effective problem-solving abilities are essential for this role.

This position requires a Registered Nurse, Licensed in State of New Jersey, with current acute care clinical knowledge and a broad-base medical/surgical background. Effective interaction and communication skills are vital, as well as the ability to work collaboratively within the health-system with patients and families, and with multidisciplinary team members.

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