Precertification & Pre-Service Appeals Nurse in Princeton, New Jersey at NJ CURE

Job Description

CURE Auto Insurance is a leading direct writer of auto insurance in New Jersey, Pennsylvania, and Michigan. CURE offers a great working environment, competitive salary, and a comprehensive benefits package which includes health and dental coverage, life and disability insurance, 401k with a generous company match, and much more!

CURE is seeking a skilled and motivated Precertification & Pre-Service Appeals Nurse to join our team. In this role, you will be the clinical bridge between provider orders and insurance approval. You will evaluate clinical documentation against medical necessity criteria, secure prior authorizations, and manage the pre-service appeals process. Your clinical expertise will assist with medical management of PIP claims and directly prevent administrative delays to stay in compliance with New Jersey precertification guidelines.

Essential Job Functions:

 Prior Authorization Management: Review treatment plans to determine insurance authorization.

 Clinical Review: Analyze patient charts, physician notes, and diagnostic results to determine if treatment is appropriate as requested or to escalate to a physician for a review through physician review, peer review, or an Independent Medical Exam.

 Pre-Service Appeals: In the event of a pre-service dispute, investigate the root cause, compile necessary clinical arguments, and process formal pre-service appeal responses.

 Collaboration: Partner closely with physicians, advanced practice providers, and staff to obtain additional charting documentation or facilitate peer-to-peer reviews. Works closely with PIP representatives on case management.

 Compliance: Accurately and timely review and document all authorization statuses, reference numbers, and appeal outcomes

 Other related tasks as assigned

Experience/Qualifications:

 Education: Graduate of an accredited School of Nursing (Associate or Bachelor’s degree).

 Licensure: Active, unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN/LVN) license in the state of New Jersey.

 Experience: * Minimum of [2-3] years of clinical nursing experience

 Minimum of [1-2] years of experience in Precertification, Case Management, or Managed Care.

 Detail-oriented with strong written and verbal communication skills.

 Must be organized and have the ability to multitask while prioritizing work.

Benefits:

 Comprehensive health benefits, including medical, dental, and vision coverage

 Generous paid time off (PTO days, sick days, and holidays)

 Flexible spending options with FSA & HSA plans

 Life and AD&D insurance

 401(k) with company match

 Voluntary benefits such as legal services, pet insurance, and identity & fraud protection

 24/7 Employee Assistance Program (EAP) for employees and their families

 Health & wellness perks, including gym discounts, wellness reimbursements, and reward programs

 Fun, engaging in-office events that support our culture

Physical Actions/Environment: Required job duties consist of prompt and regular attendance, ability to frequently move about the office to coordinate work with others; standing, sitting and typing for extended periods; and lifting and/or carrying up to 5 lbs. Ability to frequently communicate with others in-person, on the phone/virtually, and in writing. Ability to read, understand, process and evaluate large amounts of technical information and make related, informed decisions.

Starting Salary: $65,000-75,000 annually based on experience

Schedule: We offer flexible work hours between 8:00 AM and 5:00 PM, with options like 8–4, 8:30–4:30, or 9–5. We do our best to support individual preferences, though schedules may be adjusted as needed to ensure strong coverage and teamwork. We also offer a hybrid schedule: team members work onsite four days a week and can work remotely one day a week.

Location: Princeton, NJ

We recruit, hire, employ, train and promote, and compensate individuals based on job-related qualifications and abilities. We respect the dignity and worth of each individual and are committed to an employment environment that is free from all forms of employment discrimination. CURE Auto Insurance provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, pregnancy, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Disclaimer: This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. This job description may be subject to change at any time. Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.