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Registered Nurse - Case Manager
Contract to Hire: Hopewell, New Jersey, US
Salary Range: 33.00 - 34.00 | Per Hour
Job Code: 368986
End Date: 2026-05-27
Days Left: 26 days, 22 hours left
Job Title: Clinical RN I – Utilization Management (Inpatient Case Management)
Job Location: Hopewell, New Jersey 08534 (Onsite)
Job Duration: 3 Months Contract
Pay Rate: $33.00 to $34.00/hr
Job Description:
Role Summary
- The Clinical RN I – Utilization Management (Inpatient Case Management) is responsible for conducting structured pre-pay and post-pay clinical documentation audits in alignment with state audit requirements and internal guidelines.
- This role involves reviewing clinical documentation, validating authorizations, and comparing cases against medical necessity criteria (MCG) to support payment integrity and compliance.
- The RN works within defined workflows and guidelines and does not make final medical necessity determinations independently, but escalates cases as required.
Key Responsibilities
- Pre-Pay / Post-Pay Audit Execution
- Perform daily clinical documentation audits using the State Audit Process Guide
- Review claims from daily triage reports and process cases individually
- Access and evaluate claim documentation via ECM/DMS systems
- Review audit findings documented within case files
- Clinical Documentation Review
- Assess clinical records for completeness and accuracy
- Validate authorizations using Care Radius
- Apply and compare MCG criteria with audit findings
- Attach relevant supporting clinical criteria for audit decisions
- Audit Documentation & Tracking
- Document findings using standardized audit templates
- Clinical findings
- Ensure accurate and timely audit logs
- Compliance & Quality Assurance
- Adhere to state regulations, internal policies, and confidentiality standards
- Identify documentation gaps and escalate as needed
- Maintain consistency and accuracy in audit processes
- Collaboration & Communication
- Communicate audit findings with internal teams and leadership
- Participate in training, calibration sessions, and quality reviews
- Implement feedback to improve audit performance
Systems & Tools:
- Excel (Audit Tracker & Reporting)
- ECM / DMS (ITS) – document management
- Care Radius – authorization validation
- MCG – medical necessity guidelines
- Outlook / MS Teams – communication
Required Qualifications
- Active, unrestricted Registered Nurse (RN) license
- ASN or BSN degree
- Strong analytical and documentation skills
- Ability to follow structured workflows and apply clinical criteria
Preferred Qualifications
- Experience in pre-pay or post-pay audits
- Familiarity with MCG guidelines
- Experience with audit trackers and document systems
- Exposure to state or regulatory audits
The Company offers the following benefits for this position, subject to applicable eligibility requirements: medical insurance, dental insurance, vision insurance, 401(k) retirement plan, life insurance, long-term disability insurance, short-term disability insurance, paid parking/public transportation, paid time off, paid sick and safe time, hours of paid vacation time, weeks of paid parental leave, and paid holidays annually – as applicable.
Job Requirement
- Utilization Review Nurse
- Utilization Management Nurse
- UM Nurse
- Inpatient Case Manager (RN)
- RN Case Manager
- Clinical Case Manager
- Nurse Case Manager
- Clinical Review Nurse
- Clinical Documentation Review Nurse
- Clinical Documentation Specialist (RN)
- DRG Validation Nurse
- Clinical Auditor (RN)
- Nurse Auditor
- Audit Nurse
- Payment Integrity Nurse
- Quality Assurance Nurse (Clinical)
- Managed Care Nurse
- Health Plan Nurse
- Medical Review Nurse
- Care Management Nurse
- Prior Authorization Nurse
- Authorization Review Nurse
- Registered Nurse Case Manager
- Clinical Analyst (RN)
- Population Health Nurse
- Care Coordinator (RN)
Reach Out to a Recruiter
- Recruiter
- Phone
- Prince Singh
- prince.singh@collabera.com
Apply Now
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