CLINICAL REVIEW RN PRN

About the Area

With the help of Cooper, I have obtained my Epic Certification as well as my Masters in Business Administration. Cooper has really been supportive and really helpful in helping me to develop professionally and personally they really believe in a strong work-life balance.

Short Description

• Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity.
• Performs utilization review in accordance with all state mandated regulations.
• Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues.
• Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers.
• Completes documentation of review and denial processes in the EPIC Case Management Module. Responds to requests from the payer for all required information and treatment plans.
• Reviews and validates physician’s orders, reports progress and unusual occurrences on patients to the payer.

Experience Required

• 3-5 years of recent clinical experience, preferably in area of population specialty.
• Experience in utilization management or review preferred.
• Knowledge and understanding of disease protocols and clinical pathways for commercial and government payors. Familiarity with Interqual and Millimen guidelines and regulatory mandates preferred.
• Strong communication (written and verbal) and critical thinking skills required. Professional and effective presentation skills required.

Education Requirements

• Bachelor’s degree in Nursing preferred.

Special Requirements

• Monday availability is required.

About the Role

AtCooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development.

Benefits

• We offer a wide range of benefits to ensure that our staff have everything they need to succeed both at work and at home.

Awards and Designations

• Cooper University Health Care is recognized by many independent, national organizations for our standards of quality, excellence and safety.

Military and Veterans

• Cooper is proud to employ veterans and active military from every branch of the armed services as part of our Cooper team. Their contributions to our organization, our community, and our patients are highly valued and appreciated.

Nursing

• Nursing At Cooper, teamwork, respect and professional development are in our DNA. Be part of our team and on the forefront of innovation at the area’s leading academic health system. A Cooper nurse is ready to learn, ready to teach, and above all – ready first.

Cooper in the Community

• We take our role in the community very seriously. With a mission to serve, to heal and to educate, the Cooper Community Health Outreach Team provides several health education programs, presentations and consultations.

Pay

The New Jersey Pay Transparency Act requires disclosure of the pay range for this position. A salary offer will vary based on the job role, candidate experience, qualifications, internal pay equity and market data.

Schedule

Monday availability is required.