Clinical Denials Utilization Review RN - FT - Day - Utilization Resource Management Pennington NJ
Capital Health (US) · Posted Nov 2, 2026
- Pennington, New Jersey, United States
- Full-time
- $87K–$114K per year
- 5+ years
Performs Utilization Review function for Capital Health related to third party reimbursement, denials, appeals and clinical audits for inpatient cases.
Compensation
Pay Range: $86,964.80 - $113,672.00
Responsibilities
- Monitors inpatient utilization process and ensures that process is performed adequately on all inpatients in accordance with applicable standards, regulations and payer contracts.
- Actively supports denial and appeal process for the department.
- Interfaces with Health Information Management (HIM) and billing departments to coordinate clinical components to ensure appropriate reimbursement.
- Performs accurately chart and utilization review audits as directed.
- Supports Capital Health Utilization Committee with analysis of clinical outcomes data.
Requirements
- Graduation from an accredited School of Registered Nursing
- Nice to have: inpatient denial appeal experience