Nurse Practitioner (Ocean County, New Jersey)

As a Nurse Practitioner in Post Acute Care, you will oversee clinical operations for CareCentrix markets, including Utilization Management reviews, discharge coordination, readmission management, and post-discharge follow-up. You will work with Onsite Nurse Liaisons and market engagement directors to address facility discharge barriers including clinical rounds with nurse teams to support PAC length of stay and readmission management. Your role involves peer-to-peer conversations with physicians and medical necessity reviews using InterQual, MCG, and CMS criteria. You will manage PAC facilities such as SNF, IRF, and LTCH, and develop training and quality improvement interventions to support optimal PAC outcomes.

• Oversee performance guarantees and PAC Facility metrics for quality and compliance.
• Implement clinical and non-clinical performance improvements.
• Conduct facility rounds to assess relationship status and clinical integration.
• Collaborate with PAC Providers to attend IDT, Care Plan meetings and ensure regulatory compliance.
• Guide associates on clinical and non-clinical issues and case reviews.
• Educate teams on PAC needs, discharge planning, and readmission reduction.
• Facilitate proactive discharge planning and peer-to-peer discussions.
• Ensure complete clinical documentation and escalate for denial discussions.
• Participate in CareCentrix coordination, management, and education activities.
• Maintain strong relationships with PAC facilities and stakeholders.
• Review hospitalization and intervention metrics.
• Evaluate PAC facility readiness and recommend partnership adjustments.
• Collaborate with Account Management and Health Plan leadership.
• Interface with CareCentrix leadership and executive team.
• Ensure standards and policies are delivered within budget.
• Complete annual Inter-rater reliability testing and case audits.
• Achieve SLA metrics and implement risk mitigation plans.
• Lead innovation and special projects for member outcomes.
• Develop clinical staffing plans and training programs.
• Perform other duties as assigned.
• Ability to travel 25-50%
• Occasional weekend work

Qualifications:

• Master’s degree in nursing, licensed as an advanced practice nurse, ANCC or AANP Board certified. Specialty in Geriatrics or Adult preferred.
• Minimum of 5 years’ clinical experience, with 3 years in utilization management or managed care.
• Expertise in Post Acute Care and regulatory standards.
• Excellent communication and interpersonal skills.
• Quality improvement
• Adherence to HIPAA and compliance programs.
• Proficiency in Microsoft Office and clinical software.
• Ability to work independently in a fast-paced environment.
• Knowledge of the healthcare community in the assigned market.
• Valid driver’s license and proof of automobile insurance.

Preferred Skills:

• Clinical background working in nursing homes or supervising staff in nursing homes, Clinical Quality Program design, Utilization Management Plan implementation, working in a managed care plan/risk bearing entity.
• Leading and managing clinical affordability initiatives.
• Successful experience in managing a team of professionals (NPs, RNs, etc.) to achieve overall program/health plan goals.
• Ability to stay on top of trends in the health care industry with particular focus on competitive analysis, growth, innovation and clinical technology.
• Ability to compile and analyze data to be used for management, differentiation, and marketing purposes.
• Excellent public presentation skills.
• Highly organized and able to manage multiple projects, people and deadlines at one time.

What we offer:

• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match
• Generous PTO, 401K Savings Plan, Paid Parental Leave, and more
• Advancement Opportunities, professional skills training, and tuition /exam reimbursement
• Walgreens Discount - receive up to 25% off eligible items

trix maintains a drug-free workplace.

#IDCC

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

CareCentrix accepts applications on an ongoing basis until a candidate is identified.