Remote utilization review nurse jobs in Hoboken, New JerseyCreate job alerts

Job Description Role Overview We’re seeking experienced Utility Management Nurses to support a client’s healthcare product development by leveraging expertise in insurance coding and hospital revenue management workflows. This role involves collaborating with hospital systems to align medical documentation with insurance policies, ensuring accurate coding and optimal reimbursement outcomes. Key Responsibilities * Insurance Coding & Revenue Cycle Alignment: Review, audit, and optimize insurance coding practices across hospital systems to ensure compliance and maximize reimbursement accuracy. * Workflow Analysis: Evaluate existing revenue management workflows and recommend improvements tailored to client’s AI-driven documentation tools. * Clinical Data Interpretation: Translate complex clinical notes into standardized coding formats (ICD-10, CPT, HCPCS) aligned with payer policies. * Policy Matching: Assess coding accuracy against insurance guidelines and payer documentation requirements. * Product Development Collaboration: Work closely with client’s engineering and product teams to refine AI models that automate or assist with medical coding and documentation. * Compliance & Quality Assurance: Ensure alignment with HIPAA, CMS, and payer-specific coding regulations. Required Qualifications * Licensure: Registered Nurse (RN) or equivalent clinical background. * Experience: Minimum 3–5 years in medical coding, clinical documentation improvement (CDI), or revenue cycle management. * Certifications: CPC, CCS, or CRC certification preferred. * Domain Expertise: Familiarity with hospital billing systems, payer policy interpretation, and coding audit procedures. * Analytical Skills: Strong understanding of clinical documentation standards and payer logic. * Tech Savvy: Comfortable working with EHR systems (Epic, Cerner, Meditech) and documentation review software. Preferred Qualifications * Experience working within hospital revenue integrity teams or insurance utilization management. * Exposure to AI-powered healthcare documentation tools or automated coding systems. * Ability to identify and flag edge cases or policy exceptions in automated workflows. * Strong collaboration skills with cross-functional (engineering, compliance, and data) teams. Engagement Model • Contract / Part-time (Remote/In person) — Flexible hours with collaboration during U.S. business hours. In person in San Francisco is a plus

Job Description Registered Nurse / Clinical Editor / Proofer - Remote, New York State (#25297) • Location: Remote, • Employment Type: Full-time, • Hourly Rate: $45/hr About Greenlife Healthcare Staffing: Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals. Position Overview: We are seeking a detail-oriented Registered Nurse with strong editorial skills to review NYS Dispute Resolution and External Review determinations. This remote position combines clinical expertise with editorial precision to ensure accurate, compliant, and professionally presented case documents while improving team performance through error tracking and staff training. Why Join Us? • Work Schedule: Full-time, Remote. Sunday to Thursday (9:00 AM - 5:30 PM), • Professional Growth: Gain valuable experience in healthcare policy and medical editing, • Impactful Work: Ensure accuracy and compliance in state healthcare dispute resolutions Key Responsibilities: This individual will review all NYS Dispute Resolution and External Review determinations for accuracy of decisions, mathematical determinations, content, grammar, punctuation, and state-required conventions. They will utilize their clinical knowledge and editorial skills to produce a final, clean copy for each case determination. They will track errors and retrain clinical and administrative staff to mitigate production errors. • Conduct a thorough review of pre-final dispute determinations using checklist tools., • Make clinical and mathematical edits to responses using provided case documentation, as necessary., • Consult with team members and supervisors as necessary to improve the final product., • Complete edits check of content, references, grammar, spelling, and punctuation before release of final product., • Maintain tracking and trending of errors and use findings to analyze areas of concern and highlight areas of improvement., • Will provide technical assistance and conduct/participate in staff huddles., • Other activities as may be deemed necessary Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives Requirements Qualifications: • Education: Baccalaureate degree in Nursing or a graduate of an approved RN program, • Licensure: Active New York State RN license, • Experience:, • Must have a minimum of 2 years of experience in an acute care facility, preferably in medicine/surgery or special care units, and one to 3 years of experience in acute care utilization review., • Must have post-graduate studies demonstrating proficiency in writing, editing, and proofing skills., • Technical Skills: Must have knowledge and experience with electronic medical records, including coding, quality, and clinical charting., • Soft Skills: Must have the ability to oversee, problem-solve, and work collaboratively with peers, medical, analytical, and administrative support staff., • Competitive Compensation: Earn $45 per hour, • Comprehensive Benefits:, • Vacation Leave, • 6 Major Paid Holidays per year, • 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act, • License Reimbursement after 1 year of employment, • Health insurance is subject to plan eligibility requirements, • 401k Matching eligibility after 1 year of employment, • Benefits from Paychex, such as Payactiv, • GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc.

Role Overview We’re seeking experienced Utility Management Nurses to support a client’s healthcare product development by leveraging expertise in insurance coding and hospital revenue management workflows. This role involves collaborating with hospital systems to align medical documentation with insurance policies, ensuring accurate coding and optimal reimbursement outcomes. ### Key Responsibilities - Insurance Coding & Revenue Cycle Alignment: Review, audit, and optimize insurance coding practices across hospital systems to ensure compliance and maximize reimbursement accuracy. - Workflow Analysis: Evaluate existing revenue management workflows and recommend improvements tailored to client’s AI-driven documentation tools. - Clinical Data Interpretation: Translate complex clinical notes into standardized coding formats (ICD-10, CPT, HCPCS) aligned with payer policies. - Policy Matching: Assess coding accuracy against insurance guidelines and payer documentation requirements. - Product Development Collaboration: Work closely with client’s engineering and product teams to refine AI models that automate or assist with medical coding and documentation. - Compliance & Quality Assurance: Ensure alignment with HIPAA, CMS, and payer-specific coding regulations. ### Required Qualifications - Licensure: Registered Nurse (RN) or equivalent clinical background. - Experience: Minimum 3–5 years in medical coding, clinical documentation improvement (CDI), or revenue cycle management. - Certifications: CPC, CCS, or CRC certification preferred. - Domain Expertise: Familiarity with hospital billing systems, payer policy interpretation, and coding audit procedures. - Analytical Skills: Strong understanding of clinical documentation standards and payer logic. - Tech Savvy: Comfortable working with EHR systems (Epic, Cerner, Meditech) and documentation review software. ### Preferred Qualifications - Experience working within hospital revenue integrity teams or insurance utilization management. - Exposure to AI-powered healthcare documentation tools or automated coding systems. - Ability to identify and flag edge cases or policy exceptions in automated workflows. - Strong collaboration skills with cross-functional (engineering, compliance, and data) teams. ### Engagement Model - Contract / Part-time (Remote/In person) — Flexible hours with collaboration during U.S. business hours. In person in San Francisco is a plus

Travel Nurse, Case Manager, Utilization Review, Healthcare, RN, Nursing Jobs, Medical Solutions, Flexible Schedule, High Pay, Personalized Compensation. Travel Nurse RN - Case Manager, Utilization Review - $3,029 per week at Medical Solutions summary:. The Travel Nurse RN - Case Manager, Utilization

RN- Utilization Review Nurse. Inpatient - Full Time - 100% Remote Opportunity -. VillageCare is loo Nurse, Medical Director, Healthcare, RN.

A national health services organization seeks a Clinical Review Nurse for Prior Authorization to analyze medical necessity of services. The role is remote, requiring an active New York nursing license and 2-4 years of relevant experience.

Manage the utilization review process, ensuring that healthcare services are medically necessary, appropriate, and cost-effective. Track and evaluate data related to utilization patterns, identifying trends, and developing strategies to address areas for improvement. Represent Concurrent Review and

Travel Nurse, Case Manager, Utilization Review, Healthcare, RN, Nursing Jobs, Medical Solutions, Flexible Schedule, High Pay, Personalized Compensation. Travel Nurse RN - Case Manager, Utilization Review - $3,029 per week at Medical Solutions summary:. The Travel Nurse RN - Case Manager, Utilization

A utilization nurse completes no less than 20 initial clinical reviews daily. The Case Manager is responsible for all aspects of discharge planning and utilization management/review for an assigned group of patients to determine the appropriateness of the admission and continued stay, assist in the

Review drawings, specifications, and submittals to ensure technical accuracy.

Registered Nurse – RN – Perioperative Services - Center for Community Health (CCH) - Full Time – Days (6:45AM-5:15PM). At New York-Presbyterian Brooklyn Methodist Hospital, OR nurses discover an environment where the exceptional is no exception. Each of our nurses dares to be truly excellent �

Participate in progress meetings, quality reviews, and project closeout.

A utilization nurse completes no less than 20 initial clinical reviews daily. The Case Manager is responsible for all aspects of discharge planning and utilization management/review for an assigned group of patients to determine the appropriateness of the admission and continued stay, assist in the

Our client is a nationally recognized General Contractor and Construction Manager consistently ranked among the top ENR contractors year after year.With a reputation for delivering complex, high-value projects across the commercial and multifamily sectors, they are trusted by owners and developers a

A utilization nurse completes no less than 20 initial clinical reviews daily. The Case Manager is responsible for all aspects of discharge planning and utilization management/review for an assigned group of patients to determine the appropriateness of the admission and continued stay, assist in the

We are looking for a Full Time or Part-Time Nurse Practitioner or Physician Assistant that can assist us in maintaining this high standard of care. Nurse Practitioner Brooklyn, NY $Top. We are a fast growing Private Pediatric Practice practice and we are looking to add another Nurse Practitioner or

A utilization nurse completes no less than 20 initial clinical reviews daily. The Case Manager is responsible for all aspects of discharge planning and utilization management/review for an assigned group of patients to determine the appropriateness of the admission and continued stay, assist in the

Registered Nurse, RN Reports findings of ongoing observations/assessments to the designated Charge Nurse, Nursing Supervisor, &/or Unit Manager. Registered Nurse, RN utilizes the nursing process in the care of designated Residents, administers medications & treatments to residents, & documents appro

Nurses Make It Possible Registered Nurse - RN - Emergency Department (ED) - Full-time - Days At NewYork-Presbyterian Hospital, Emergency Department (ED) nursing is a moment-to-moment, career-transforming experience. Here, ED nurses independently assess conditions and rapidly arrange multidisciplinar

Participates in utilization review of medical records as assigned. Participates in peer review and performance improvement as assigned.

Registered Nurse - RN - Labor and Delivery (L&D) - Full-time - Nights At New York Presbyterian Brooklyn Methodist Hospital, Women's Health nurses have created a supportive, compassionate environment for all phases of ante- through post-partum care. Nurses Make It Possible Discover the epicenter of O

Participates in utilization review of medical records as assigned. Participates in peer review and performance improvement as assigned.

Nurses Make It Possible Registered Nurse - RN - Emergency Department (ED) - Full-time - Swing At NewYork-Presbyterian Hospital, Emergency Department (ED) nursing is a moment-to-moment, career-transforming experience. Here, ED nurses independently assess conditions and rapidly arrange multidisciplina

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. The Registered Nurse Care Manager at Williamsbridge Center provides essential nursing care in a skilled nursing facility, focusing on the health and well-being of residents. Williamsbridge Center is hiring a Registe

Participates in utilization review of medical records as assigned. Participates in peer review and performance improvement as assigned.

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. The Registered Nurse Care Manager at Williamsbridge Center provides comprehensive nursing care for residents in a skilled nursing facility. Williamsbridge Center is hiring a Registered Nurse (RN) for our Skilled Nur

Nurse Practitioner Famiy or PEDS Bilingual English & Spanish Passaic, NJ. We are a fast growing Private PEDS Practice practice and we are looking to add another Nurse Practitioner or Physician Assistant to our amazing team. We are looking for a Full Time or Part-Time Nurse Practitioner or Physician

Registered Nurse, Care Manager, Case Management, Skilled Nursing Facility, Patient Care, Medication Administration, Infection Control, Long-Term Care, Healthcare, Multidisciplinary Team. Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. The Registered Nurse Care Ma

Current licensure in NYS as a Registered Professional Nurse or Licensed Practical Nurse,. Registered Nurse Unit Manager, RN Job Summary. Registered Nurse Unit Manager, RN perform professional supervision, guidance and direction to staff in both clinical and personnel issues on the Sub-Acute (Short T

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. The Registered Nurse Care Manager at Williamsbridge Center provides essential nursing care and support to residents in a skilled nursing facility. Williamsbridge Center is hiring a Registered Nurse (RN) for our Skil

Case Management Nurses coordinate long-term care for their patients. As a Case Management Nurse, you’ll likely work with specific groups of patients.

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. The Registered Nurse Care Manager at Williamsbridge Center is responsible for providing comprehensive care and support to residents in a skilled nursing facility. Williamsbridge Center is hiring a Registered Nurse (

Nurse Practitioner or Physician Assistant - Cardio, Bronx, NY $140K - $160K. Location: Bronx, NY We are looking for a Nurse Practitioner or a Physician Assistant to join our outstanding team in Bronx, NY. NY State Licensed Nurse Practitioner or Physician Assistant.

Job Title: Lead Registered Nurse. The Lead Registered Nurse at Restore works hand in hand with the General Manager and is responsible for the successful oversight and onboarding of studio nursing staff, administration of all medical therapies, client education, membership promotion, and other assign

As a Registered Nurse (RN), Provide advice & support to the Residents and their families. Current State Registered Nurse RN License. Registered Nurse, Case Management, Skilled Nursing Facility, Resident Care, Long-Term Care, Infection Control, Healthcare, Team Collaboration, Patient Support, Rehabil

Job Title: Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN). LPN/LVN (License Practical Nurse).

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. As a Registered Nurse Care Manager at Williamsbridge Center, I provide comprehensive support and care to residents in a skilled nursing facility, ensuring adherence to quality standards and infection-control protoco

The Patient Care Coordinator, in collaboration with and under the direction of the Administrative Nurse Manager participates in the coordination/implementation of fiscal, human, and other resources needed to provide patient care services for a designated unit, location or patient population on a des

You will review patient insurance information and coordinate activities involved in each individual care plan and make sure that pertinent findings are shared with family and professional caregivers.

Location: Bronx, NY We are looking for a Nurse Practitioner or a Physician Assistant to join our outstanding team in Bronx, NY. NY State Licensed Nurse Practitioner or Physician Assistant. Nurse Practitioner or Physician Assistant - GYN Must have Experience!.

Montefiore Medical Center is seeking a Registered Nurse (RN) Clinical Coordinator, ICU - Intensive Care Unit for a nursing job in Fort Lee, New Jersey. The Montefiore Patient Care Coordinator maintains standards of the practice for nursing as defined by the American Nurses Association Code of Ethics

You will review patient insurance information and coordinate activities involved in each individual care plan and make sure that pertinent findings are shared with family and professional caregivers.

Nurse Practitioner Family - Brooklyn, NY 11209. We are a fast-growing Private Practice Internal Medicine and we are looking to add another Nurse Practitioner or Physician Assistant to our amazing team. We are looking for a Full Time or Part-Time Nurse Practitioner or Physician Assistant that can ass

You will review patient insurance information and coordinate activities involved in each individual care plan and make sure that pertinent findings are shared with family and professional caregivers. Current NYS RN (Registered Nurse) license and registration required.

Posted job title: Clinical Nurse Coordinator. Montefiore Medical Center is seeking a Registered Nurse (RN) Clinical Coordinator, CCU - Coronary Care for a nursing job in Edgewater, New Jersey. The Montefiore Patient Care Coordinator maintains standards of the practice for nursing as defined by the A

A Nurse Practitioner's responsibilities include helping with all aspects of patient care, including diagnosis, treatments, and consultations. We are looking for a Nurse Practitioner to join our team who will provide holistic and quality care to our patients.

New York State License for Registered Professional Nurse and current registration or valid permit to practice in New York State as an RN required. Posted job title: Clinical Nurse Coordinator. Montefiore Medical Center is seeking a Registered Nurse (RN) Clinical Coordinator, ICU - Intensive Care Uni

Benefits for Registered Nurses (RN) * $500 bonus for qualified RN's* * Paid Time Off (PTO) and flexible schedule * Medical, Dental and Vision Coverage * 401k * Weekly pay and direct deposit * 24/7 On Call for support * Career advancement * Nurse Referral bonus * Training opportunities * Respiratory