Registered Nurse- UR Manager, Central Utilization Review- Full Time, Days, 8 AM - 4 PM, Morristown NJ

Key responsibilities Lead, coach, and support the Central UR nurses and Insurance Specialists; manage assignments, workflow priorities, and staff performance. Ensure timely initial and continued-stay reviews, authorization follow-up, payer communication, and escalation of cases at risk for denial. Partner with physician advisors and care teams on level-of-care questions, peer-to-peer reviews, potential account downgrades, and clinical appeals.

Analyze denial, appeal, authorization, and UR performance data to identify trends and lead corrective action. Work with hospital case management, medical, nursing, and revenue cycle leaders to resolve barriers and improve care progression. Identify recurring payer and Independent Review Organization issues and share findings with Managed Care Contracting and appeals leadership.

Develop clear workflows, education, and tools in response to performance gaps, payer requirements, and regulatory changes. Monitor improvement plans and help teams sustain results across AHS hospitals. Required Graduate of an accredited school of nursing with a current Registered Nurse license in the applicable state.

Bachelors degree in nursing, Advanced degree in business, or health care administration preferred. Leadership experience in an acute care setting. Experience in acute care case management or utilization review.

Strong clinical judgment, communication, data analysis, and team leadership skills. Preferred ACM-RN or CCM certification. Experience with payer authorizations, clinical denials and appeals, and physician advisor workflows.

Case management training through a professional organization.

Full-Time