Registered Nurse - Utilization Management - Full Time

About the role

The RN Utilization Management is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical information to determine the appropriate level of care assignment, along with the completion and submission of reviews to insurance payers with appropriate follow-up.

Qualifications

• Graduate of an accredited school of nursing required.
• Bachelor's in nursing Required.
• Utilization/Coding certification preferred or in process.
• Current licensure as a Registered Nurse in the State of New Jersey or current multi state license required.
• Effective Jan 2026: Current MCG (Milliman Clinical Guideline) certification required within 2 years of hire or transfer.
• Current incumbents must obtain MCG by 1/1/2027.
• American Heart Association BLS certification required within 6 months of hire or transfer.
• Current incumbents must obtain BLS by 6/30/2026.
• Prior Utilization/insurance case management experience Preferred.
• Experience on MCG/InterQual, HEDIS, CDI or Quality review preferred.
• Recent acute care Medical-Surgical nursing experience preferred.
• Proficient in using common computer software applications preferred (Word, Excel formatting).
• Proficiency in Clinical Applications preferred at time of hire; incumbents within position will be trained appropriately and then skill will be required for this position within 30-60 days from date of hire.

Performance Expectations

Demonstrates the technical competencies as established on the Assessment and Evaluation Tool.

Work Environment

This position requires desk/computer work a majority of the time. There is some standing, walking and occasional lifting up to 20 pounds. The essential functions for this position are listed on the Assessment and Evaluation Tool.

Reporting Relationship

This position reports to department leadership.

Total Rewards

At AtlantiCare, we believe in supporting the whole person. Our market-competitive total rewards package is designed to promote the physical, emotional, social, and financial well-being of our team members. We offer a comprehensive suite of benefits and resources, including:

• Generous Paid Time Off (PTO)
• Medical, Prescription Drug, Dental & Vision Insurance
• Retirement Plans with employer contributions
• Short-Term & Long-Term Disability Coverage
• Life & Accidental Death & Dismemberment Insurance
• Tuition Reimbursement to support your educational goals
• Flexible Spending Accounts (FSAs) for healthcare and dependent care
• Wellness Programs to help you thrive
• Voluntary Benefits, including Pet Insurance and more

Benefits offerings may vary based on position and are subject to eligibility requirements. Join a team that values your well-being and invests in your future.

Pay Transparency

To support the Fair Compensation Strategy by the US Govt., HR Dept., clients are required to adhere to "Pay Transparency Law" in impacted states, which mandate employers to list salary ranges in job advertisements and promotions.

Equal Opportunity Employer

AtlantiCare is an Equal Opportunity Employer.