Job Description
- Lead AHS clinical denial prevention and management initiatives to support appropriate level of care. Works closely with AHS revenue cycle leaders to complete current state assessment, evaluate, and implement leading practices for system standards and/or local market programs needed. Evaluates clinical denials and appeals data, documentation, and workflows to identify and address process and performance gaps.
- Lead successful denials prevention and performance improvement for AHS hospitals. Monitors and manages AHS hospital performance to targets and leads corrective action plans needed to achieve organizational targets.
- Collaborates with Executive Director of Case Management to address barriers and gaps in utilization review and authorization confirmation services. Provides hospitals with performance data analytics to make decisions and drive improvement. Works with hospital and market leaders to identify when improvement plan is needed and follows up to ensure successful execution.
- Work with Managed Care Contracting to identify and address payer and Independent Review Organization (IRO) issues. Collects and collates data from hospitals on payer issues and IRO results. Provides AHS managed care leadership team with data to address issues with payers including avoidable days, contract violations, and process issues. Provides input to contract language to support AHS case management service needs. Participates with AHS Appeals with Physician Advisor in identifying and addressing trends with payor medical directors.
- Provide oversight for appeals assigned to the Physician Advisor (PA) and potential account downgrades. Supports the development and implementation of clinical appeals workflow to incorporate AHS Appeals PA review prior to any account downgrade. Works with Conifer and Tenet Appeals PA to identify opportunities for improvement including documentation and process. Utilizes findings for process improvement and hospital PA and case management education. Identifies trends to address with managed care contracting and plan medical directors.
- Uses tools to address performance barriers. Develops and implements best practices to achieve organizational goals through effectively leading and managing change in a matrix environment. Oversees the implementation of action plans and monitors progress toward goals assisting with addressing barriers and challenges and adjusting as needed in a supportive, synergistic manner. Collaborates with medical and nursing leadership, as well as case management members to develop and implement methods to optimize use of hospital and post-acute services.
- Manages multi-disciplinary process improvement by utilizing excellent communication and servant leadership skills to challenge status quo and positively influence administrative teams and physicians to change processes to improve performance.
- Provides analysis and education regarding regulatory and clinical changes impacting inpatient and post-acute care processes and reimbursement. Provides education and tools for educating physicians and staff regarding programs and processes.
Works in alignment with hospital and revenue cycle leadership teams and consistently demonstrates ability to:
- Conduct financial analysis, develop business plans and secure approval for programs.
- Develop strategies to manage and prevent disputes and improve revenue cycle processes.
- Build trusting relationships with hospital and revenue leaders to successfully implement new programs.
- Build collaborative partnerships and lead cross functional teams to execute on plans and proposals.
- Identify process inefficiencies via root cause analysis and design workflow to address opportunities identified.
- Develop and implement action plans managing follow up to achieve outcomes.
- Implement targeted process changes including ongoing metric monitoring and management to achieve goals and drive improvement
Supervisory Responsibilities
The UR Nurses and Insurance specialist will report to this Central UR Manager
Education
- Graduate of an accredited school of nursing.
- Advanced degree in Business, Nursing and/or Health Care Administration required.
Experience
- Leadership experience care and management of acute hospitalized patients.
- Experience in acute care case management,
- Case management training from a professional Case Management organization, preferred.
Required Licenses, Certifications and/or Registrations
Certificates ACMA or CCM preferred
Licenses Current state license as a Registered Nurse
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
