Utilization Reviewer (RN) - Emergency Department, Full Time, Days, 8 AM - 4 PM, Atlantic Health Overlook Medical Center

Job Description

Utilization Reviewer (RN) - Emergency Department
Atlantic Health System - Overlook Medical Center
Full-Time | Days | Monday-Friday | 8:00 AM - 4:00 PM

Atlantic Health System is seeking a Full-Time Utilization Reviewer RN to support Emergency Department operations at Overlook Medical Center. The Utilization Reviewer is responsible for conducting real-time medical necessity reviews and level-of-care determinations for patients presenting to the Emergency Department. This role serves as a key liaison between clinical teams and utilization management to ensure appropriate patient status assignment, regulatory compliance, and optimal patient throughput.

Responsibilities:

• Perform concurrent medical necessity reviews for Emergency Department patients utilizing MCG and/or InterQual criteria.
• Evaluate admission, observation, and level-of-care determinations in accordance with CMS, payer, and organizational guidelines.
• Collaborate with Emergency Department physicians, hospitalists, physician advisors, and care management teams to support timely patient placement decisions.
• Provide education and guidance regarding CMS Observation Rules, Two-Midnight Rule, and documentation requirements.
• Identify potential denial risks and compliance concerns and escalate as appropriate.
• Communicate patient status determinations and pertinent clinical information to inpatient Utilization Review staff for continuity of care.
• Participate in departmental quality initiatives, data collection, reporting, and performance improvement activities related to utilization management and patient throughput.
• Maintain current knowledge of regulatory and payer requirements impacting utilization review practices.
  

Qualifications

Required:

• Graduate of an accredited School of Nursing.
• Current New Jersey Registered Nurse (RN) License in good standing.
• Strong clinical assessment and critical thinking skills.
• Excellent communication and interdisciplinary collaboration abilities.

Preferred:

• Bachelor of Science in Nursing (BSN).
• Previous Case Management, Utilization Review, or Care Coordination experience.
• Experience utilizing MCG and/or InterQual criteria.
• Knowledge of CMS regulations, Observation Status requirements, and Utilization Management principles.
• Prior Emergency Department, Acute Care, Case Management, or Clinical Documentation experience.

About Us

At Atlantic Health, our promise to our communities is; Anyone who enters one of our facilities will receive the highest quality care delivered at the right time, at the right place, and at the right cost. This commitment is also echoed in the respect, development and opportunities we give to our more than 22,000 team members. Headquarters in Morristown, New Jersey, we are one of the leading non-profit health care systems in the nation. Our facilities and sites of care include:

• Atlantic Health Morristown Medical Center, Morristown, NJ
• Atlantic Health Overlook Medical Center, Summit, NJ
• Atlantic Health Newton Medical Center, Newton, NJ
• Atlantic Health Chilton Medical Center, Pompton Plains, NJ
• Atlantic Health Hackettstown Medical Center, Hackettstown, NJ
• Atlantic Health Goryeb Children's Hospital, Morristown, NJ
• Atlantic Health CentraState Healthcare System, Freehold, NJ
• Atlantic Medical Group
• Atlantic Visiting Nurse
• Atlantic Mobile Health
• Atlantic Rehabilitation

We have more than 900 community-based healthcare providers affiliated through Atlantic Medical Group.

We have received awards and recognition for the services we have provided to our patients, team members and communities. Below are just a few of our accolades:

• Chosen for 17 years by Fortune as one of the magazine's "100 Best Companies to Work For."
• Atlantic Health Morristown and Atlantic Health Overlook Named by Newsweek as two of the "World's Best Hospitals" in 2026.
• Atlantic Health Morristown and Atlantic Health Overlook ranked within the top three hospitals in New Jersey by U.S. News & World Report's 2025-2026 Best Hospital rankings.
• Atlantic Health scored four "A" grades by The Leapfrog Group in its Fall 2025 Hospital Safety Grades, performance measures reflecting errors, accidents, injuries and injections, as well as systems hospitals have in place to prevent harm.
• Atlantic Health Morristown and Atlantic Health Overlook are New Jersey's only hospitals to be named among America's 50 Best hospitals by Healthgrades in 2026.
• Named by Becker's Healthcare as one of the "165 Top Places to Work in Healthcare - 2026.
• Atlantic Health Morristown, Atlantic Health Overlook, Atlantic Health Chilton and Atlantic Health Newton all Forbes Top Hospitals for 2026.
• Named by Newsweek as one of America's Greatest Workplaces for Inclusion & Diversity 2025.
• Atlantic Health rated LEVEL 9 - 2025 CHIME Digital Health Most Wired.

Atlantic Health offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members. Offerings vary based on role level (Team Member, Director, Executive). Below is a general summary, with role-specific enhancements highlighted:

Team Member Benefits

• Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full-time and part-time team members)
• Life & AD&D Insurance.
• Short-Term and Long-Term Disability (with options to supplement)
• 403(b) Retirement Plan: Employer match, additional non-elective contribution
• PTO & Paid Sick Leave
• Tuition Assistance, Advancement & Academic Advising
• Parental, Adoption, Surrogacy Leave
• Backup and On-Site Childcare
• Well-Being Rewards
• Employee Assistance Program (EAP)
• Fertility Benefits, Healthy Pregnancy Program
• Flexible Spending & Commuter Accounts
• Pet, Home & Auto, Identity Theft and Legal Insurance

____________________________________________

Note: In Compliance with the NJ Pay Transparency Act (effective Sunday, June 1, 2025), all job postings will include the hourly wage or salary (or a range), as well as this summary of benefits. Final compensation and benefit eligibility may vary by role and employment status and will be confirmed at the time of offer.

EEO STATEMENT

Atlantic Health, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran

Job Info

• Minimum Salary (Hourly Rate): 40.000000
• Maximum Salary (Hourly Rate): 70.400000
• Assignment Category: Full-time
• Hours per Week: 37.5
• Primary Shift: Day
• Salary Admin Plan: RNS