DIRECTOR CLINICAL REVIEW
Camden, New Jersey
Overview
At Cooper, our dedicated nurses are the foundation of our commitment to exceptional care. As South Jersey’s leading academic health system and only Level I Trauma Center, we deliver compassionate care across the care continuum. With a vast geographic reach encompassing urban and suburban settings, Cooper offers a diverse environment for professional nursing practice.
Success Profile
We’ve identified several DIRECTOR CLINICAL REVIEW personality traits that best fit within our organizational infrastructure, company culture, and shared values. Are you a match?
- Achiever
- Adaptable
- Good Listener
- Helpful
- Results-driven
- Self-starter
Mission and Values
At Cooper University Health Care, we’ve built an environment where everyone is passionate about learning, healing, and service. Making this mission a reality means cultivating supportive, inspiration-focused conversations between our team members at every level. We’re proud of the purpose-driven culture our team shares, and the outcomes it produces for our patients.
Cooper University Health Care is a leading academic health system where our nurses work alongside some of the best clinicians in the world to treat unique and complex cases. At Cooper, we strive to support nurses to be the best through collaborative work environments, educational and professional development opportunities, as well as career advancement. If you’re looking to learn, grow, and further your nursing career, Cooper University Health Care is the right place for you. Join us today. Learn why there are nurses … and then there are Cooper nurses.
- Kathy Devine, DrNP, RN, NEA-BC
SVP / Chief Nursing Executive
Employee Voices
Benefits
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Retirement
Cooper University Health Care offers a 403(b) retirement plan administered by Fidelity Investments that enables team members to save and plan for retirement through pre-tax and post-tax (Roth) contributions. All new team members of Cooper University Health Care will have 3% of compensation automatically deducted from their pay each payroll period and directed to their account at Fidelity Investments. Deferral percentages can be changed with Fidelity at any time, once enrolled. A match contribution of 50% of the team member’s contributions up to 5% of annual salary is available once eligible.
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Medical/Dental
Cooper’s medical plans are provided by Horizon Blue Cross Blue Shield. Each of the medical plans offers flexibility and freedom to use any Cooper or network provider in Horizon Blue Cross Blue Shield’s PPO, Blue Card network. Each plan has a wide range of preferred providers and services that may have no out-of-pocket cost when using Cooper providers, depending on the plan chosen. Prescription drug coverage is included in each of Cooper’s medical plans. Dental benefits are provided through Delta Dental PPO plans and Sun Life DMO. Comprehensive vision coverage is offered through Eyemed.
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Tuition Assistance
Cooper University Health Care believes that ongoing education is important, both personally and professionally. Benefits eligible team members are able to take advantage of Tuition Assistance once 3 months of employment are completed. Cooper also provides annual assistance towards professional certifications and related organization memberships.
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Educational Partnerships
Cooper is proud to partner with world class educational institutions
- Atlantic Cape Community College
- Tomas Edison State University Bayada Scholars Program at Cooper
- Rutgers- Blackwood
- Camden County College
- Drexel University
- Gwynedd Mercy University
- Holy Family University
- Jefferson University
- La Salle University
- Our Lady of Lourdes School of Nursing
- Rowan College of Burlington County
- Rowan University
- Rowan College of South Jersey
- Rutgers Camden
- Rutgers New Brunswick
- Stockton University
- TCNJ
- Thomas Edison State University
- University of Pennsylvania
- Widener University
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Nursing Recognition and Excellence
We are always looking to highlight the amazing work of our team members. Through-out the year nurses are recognized through Daisy nomination, unit awards, and rounding recognitions. For those nominated by their leaders and peers Cooper holds Annual Nursing Excellence Awards for their clinical abilities, leadership, mentorship and commitment to upholding the Cooper mission: To serve, to heal, to educate.
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Professional Development
Cooper is committed to nurses' professional growth and development. A variety of classes and courses are offered for learning new content and skills focused specifically on current and future career goals. Cooper nurses are provided with the opportunities to become involved in precepting, mentorships, research, interprofessional education, Grand Rounds and presentations.
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Professional Governance
Professional Governance: Cooper nurses are encouraged to participate in our shared decision-making structure that gives them autonomy in defining and determining their practice. Professional governance allows for collaboration and communication across all levels of nursing to drive quality patient and workforce outcomes.
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Nursing Residency
Cooper's Nurse Residency Program provides a unique opportunity for our new-to-practice RNs to develop confidence in clinical decision-making skills, build a community with colleagues, and enhance their professional practice.
Responsibilities
DIRECTOR CLINICAL REVIEW
Camden, NJJob ID 31945Job Type Full TimeShift DaySpecialty Leadership & Non-Direct Patient CareAt Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development.
Discover why Cooper University Health Care is the employer of choice in South Jersey.
Short Description
Under the direction of the AVP of Clinical Review and Discharge Planning, the Director of Clinical Review maintains daily operations of the hospital Clinical Review Department. Excellent communication and interpersonal skills. Team building skills with the ability to function independently and interdependently as a member of the Care Management Leadership Team. Demonstrates the ability to be flexible in work schedules and coverage; this includes the ability to manage some staff remotely. Strong organizational, innovation, and problem-solving skills. Strong decision-making skills. Ability to establish strong team building with the both internal and external customers.
Directs daily UM operations for the department including staffing, schedules, recruitment, onboarding, and performance management. Responsible for maintaining budget and contributing to future budget development.
Monitors departmental performance indicators, goals and objectives that are consistent with organizational strategic goals, mission, and vision.
Monitors departmental objectives consistent with revenue cycle plan for DNFB, denials, and appeals. Monitors reports and workqueues. In collaboration with the AVP, Medical Director of UM annually evaluates the UM plan to meet compliance standards.
Maintain the quality of the review process among all personnel including development and implementation of staff audits that give meaningful and measureable data and an understanding of strengths and areas for improvement. Responsible for the development and implementation of process improvements. Reviews observation/SDS cases daily and initiates communication and referral activity to ensure correct status designation. Active participant in the Utilization Management Committee and subject matter expert who acts as a resource to the team. Recruits, evaluates, mentors, and conduct appropriate disciplinary actions for UM staff. Collaborates with Physician advisors, and AVP to assure workflows and cases are being addressed according to plan. The above are guidelines for the position but are not necessarily a delineation of all the actions/duties necessary to the job.
Experience Required
5 plus years’ experience in utilization management/review (UM/UR) or case management preferred.
Previous leadership experience required, preferred 2 years leadership experience in UM or Case Management.
Extensive knowledge and understanding of disease protocols and clinical pathways for commercial and government payors, Interqual and Millimen guidelines, and regulatory mandates.
Strong communication (written and verbal) and critical thinking skills required.
Process redesign, project and change management experience preferred. Knowledge and understanding of managed care contract language, Medicaid, CMS guidelines, and third-party payor guidelines.
Education Requirements
Bachelor’s degree in nursing required, master’s degree preferred.
License/Certification Requirements
Current NJ-RN License required. CCM, ANCC, or other related certification in Case Management preferred.