Clinical Review RN PRN

About Us:

About Cooper University Health Care

Cooper University Health Care is a leading academic health system affiliated with Cooper Medical School of Rowan University. Cooper, headquartered in Camden, New Jersey, has revenues of more than $3 billion and an A+ credit rating from both S&P and Fitch Ratings.

Cooper has nearly 14,000 team members, including more than 2,200 nurses, more than 1,200 employed physicians representing 95 specialties and subspecialties, and more than 700 advanced practice providers.

Cooper operates MD Anderson Cancer Center at Cooper as well as three hospitals – its 663-bed flagship Cooper University Hospital in Camden, its 229-bed Cooper University Hospital Cape Regional in Cape May Court House, and Children’s Regional Hospital in Camden.

Cooper University Hospital in Camden is the only Level 1 trauma center in South Jersey and the busiest in the region. The hospital has been recognized as a top-performing regional hospital by U.S. News & World Report’s Best Hospitals annual survey for six years.

More than 2.54 million patients visit Cooper’s facilities annually. Cooper’s ambulatory network encompasses three outpatient surgery centers, seven urgent care centers, a wound care center, and more than 130 physician, physical therapy, and radiology offices extending from the Delaware River to the New Jersey shore.

Cooper was named one of America’s Best Large Employers for 2026 by Forbes, ranking among the top 200 in the nation.

Visit CooperHealth.org to learn more.

Short Description:

• Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity. Performs utilization review in accordance with all state mandated regulations.
• Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues.
• Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers.
• Completes documentation of review and denial processes in the EPIC Case Management Module. Responds to requests from the payer for all required information and treatment plans.
• Reviews and validates physician’s orders, reports progress and unusual occurrences on patients to the payer.

Experience Required:

3-5 years of recent clinical experience, preferably in area of population specialty.

Experience in utilization management or review preferred.

Knowledge and understanding of disease protocols and clinical pathways for commercial and government payors. Familiarity with Interqual and Millimen guidelines and regulatory mandates preferred.

Strong communication (written and verbal) and critical thinking skills required. Professional and effective presentation skills required.

Education Requirements:

Bachelor’s degree in Nursing preferred

License/Certification Requirements:

Current NJ-RN License required.

Special Requirements:

Monday availability is required.

Salary Min ($): USD $37.00 Salary Max ($): USD $61.00