- Hunterdon Health Care System (Flemington, NJ)
- This is an in-person role. Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
- Deloitte (Philadelphia, PA)
- …clinical registered nurse, physician, physician assistant, case manager, clinical documentation specialist , utilization review , informatics RN, Quality, DRG ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk...financial concerns and other business controversy. A Clinical Documentation Specialist (CDS) works to ensure accuracy and completeness of… more
- Datavant (Trenton, NJ)
- …tools. The specialist serves as a key liaison between coding, billing, utilization review , case management, and payer relations to reduce denials and improve ... experiences to realize our bold vision for healthcare. The Specialist is responsible for identifying, analyzing, and resolving claim...of Inpatient coding experience, with a focus on denial review and resolution **You will:** + Monitor and manage… 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
- AmeriHealth Caritas (Philadelphia, PA)
- …us at www.amerihealthcaritas.com . The Community Health Choices (CHC) Home Modification Specialist works within the scope of the service definition for home ... under the Community Health Choices (CHC) Program. The Home Modification Specialist evaluates Participant needs for home accessibility/modification and the existing… more
- Penn Medicine (Cherry Hill, NJ)
- …day. Are you living your life's work? **Job Title:** Preregistration Specialist **Department:** Financial Clearance **Location:** Penn Medicine Cherry Hill- 1865 ... Route 70 E **Hours:** Mon-Fri office hours **Summary:** + The Pre-Registration Specialist reports to the Supervisor of Financial Clearance. This individual possesses… more
- Cushman & Wakefield (Trenton, NJ)
- **Job Title** Procurement Specialist **Job Description Summary** Under the direction of the Procurement Leadership, this role will assist in all aspects of ... overall vendor management on the assigned client accounts. The Procurement Specialist is expected to have Procurement, Strategic Sourcing, Contracting and Analytical… more
- Datavant (Trenton, NJ)
- …The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity ... author appeal letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers + Provide proper… more
- Jacobs (Philadelphia, PA)
- …needed; prepare monthly reports to the Director of Technical Specialists on utilization , work summaries and work projections; review designs for operability; ... difference. Jacobs is seeking a dynamic Regional Wastewater Technical Specialist to join our team in the Northeast Region...& Facilities Services (OMFS) business. As a Regional Technical Specialist , you'll assume a leading role on special projects… more
- CVS Health (Trenton, NJ)
- …We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist . The position will be a part of a specialized team who will ... all sales presentations. + Servicing of existing members and inquiries related to utilization of their product, benefits, etc. + Cross selling applicable products to… more
- Sedgwick (Trenton, NJ)
- …Fortune Best Workplaces in Financial Services & Insurance (Remote) EDI Support Specialist - Casualty **PRIMARY PURPOSE** **:** To identify, research, resolve, and ... Support Representatives on a variety of complex issues including expert review of International Association of Industrial Accident Boards and Commissions (IAIABC)… more
- Evolent (Trenton, NJ)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- GS1 US (Ewing, NJ)
- …updating, and retirement) to ensure relevance, accuracy, and effectiveness. Monitor asset utilization and coordinate regular review /update cycles. Here are a few ... badges (eg, Acclaim). + People Management: Supervise the Training Specialist role, providing coaching, performance management, and professional development support.… more
- ASM Research, An Accenture Federal Services Company (Trenton, NJ)
- …on the project in a senior administrator capacity. Considered a technical specialist in a variety of IT administrator disciplines. + Configure, monitor, and ... as needed (aside from on-call rotation). + Optimize system operations and resource utilization as well as perform system capacity analysis and planning. + Utilize… more
- ChenMed (Philadelphia, PA)
- …and explain nurse practitioner role. + Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... as part of the clinical operations team and is responsible for providing specialist patient care in nursing homes, skilled nursing facilities (SNF) and home… more