- Trinity Health (Langhorne, PA)
- …seeking an experienced Registered Nurse to join our team in Utilization Review ! The UM Registered Nurse is responsible for the coordinating and ... + CCM or Accredited Case Manager certification preferred. + Previous experience in Utilization review highly preferred. + Demonstrates ability to use problem… more
- Humana (Trenton, NJ)
- …SRO **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The… more
- CVS Health (Trenton, NJ)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Sharecare (Trenton, NJ)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Evolent (Trenton, NJ)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... + Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current,… more
- Centene Corporation (Trenton, NJ)
- …required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required or + LCSW- ... applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA… more
- ChenMed (Philadelphia, PA)
- …assess and record patients' progress and adjust and plan accordingly + Understanding utilization review and how to leverage with inpatient staff for possible ... a related clinical field preferred + A valid, active Registered Nurse (RN) license in State of...required + A minimum of one (1) year of utilization review and/or case management, home health,… more
- AmeriHealth Caritas (Philadelphia, PA)
- …Review Home Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and ... of new and/or revised work processes, policies and procedures relating to LTSS Utilization Review . + Accurately answers questions regarding CHC benefits for… more
- Datavant (Trenton, NJ)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- Penn Medicine (Philadelphia, PA)
- …into daily assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. ... quality data collection and risk management referral. Responsibilities: + Utilization management activities: monitor appropriate use of internal resources,… more
- Deloitte (Philadelphia, PA)
- …degree in nursing, medical degree, or physician assistant required + Current Registered Nurse (RN) license required + Certified Clinical Documentation Specialist ... (CRC, CCA, CCS-P, CCS, CPC, CDIP, CCM) + Experience as clinical registered nurse , physician, physician assistant, case manager, clinical documentation… more
- Penn Medicine (Philadelphia, PA)
- …into daily assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. ... your life's work? **The candidate for this position must be a seasoned med/surg nurse with a minimum of 3 to 5 years of nursing experience. Previous experience… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Knowledge, Skills and Abilities Preferred: + Knowledge of evidence-based criteria, utilization review , discharge planning and case management. Licenses and ... Certifications Required: + NJ State Professional Registered Nurse License. 172368 Minimum rate of $112,114.08 Annually HMH is committed to pay equity and… more