- 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
- Cognizant (Trenton, NJ)
- …Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- Centene Corporation (New York, NY)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... member's - ages 0-18.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact… more
- City of New York (New York, NY)
- …required; make professional recommendations accordingly. - Keep abreast of medical and utilization review techniques and developments relative to the nursing ... Nurse in the Bureau of Medical and Professional Review (BMPR) of Home Care Services Program. As the...- 50935 Qualifications 1. A valid New York State Registered Nurse License and completion of one… more
- Centene Corporation (New York, NY)
- …of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required ... Utilization Management** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team… more
- Atlantic Health System (Basking Ridge, NJ)
- …Visiting Nurse , part of Atlantic Health System, is seeking a full-time hospice Registered Nurse to work 8AM- 4PM in the Somerset County area, including ... of care for the patient and family Ensures appropriate utilization of services + Maintains visit productivity standards +...Program- Associates Degree 2. Current state licensure as a Registered Nurse . 3. BLS certification. Preferred: 1.… more
- Centene Corporation (New York, NY)
- …+ LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: $26.50 - $47.59 per hour Centene ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- Centene Corporation (New York, NY)
- …+ LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: $26.50 - $47.59 per hour Centene ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more
- Mount Sinai Health System (New York, NY)
- …Additional Detail** + Licensure: New York State License with current registration as a registered nurse . + State Certification: Certified by the New York State ... the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion...follows: a. Is a graduate of New York State registered Nurse Practitioner Program or equivalent OR… more
- Mount Sinai Health System (New York, NY)
- …Additional Detail** 1. Licensure: New York State License with current registration as a registered nurse . 2. State Certification: Certified by the New York State ... the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion...follows: a. Is a graduate of New York State registered Nurse Practitioner Program or equivalent OR… more
- Mount Sinai Health System (New York, NY)
- …REQUIREMENTS** 1. Licensure: New York State License with current registration as a registered nurse . 2. State Certification: Certified by the New York State ... follows: 3. Is a graduate of New York State registered Nurse Practitioner Program or equivalent OR...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
- Humana (Trenton, NJ)
- …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) Compact license, with no disciplinary action + 3 ... caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes...Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation… more
- City of New York (New York, NY)
- …requirement above, candidates must have three years of full-time satisfactory experience as a Registered Nurse , two of which must have been in a supervisory ... with the referring agency and the client's caseworker. 2. Review all available clinically relevant material, including referral information,...have three years of full-time satisfactory experience as a Registered Nurse , one of which must have… 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
- Hackensack Meridian Health (Edison, NJ)
- …systems; Google Docs, EPIC. **Licenses and Certifications Required** : + NJ State Professional Registered Nurse License. + AHA Basic Health Care Life Support HCP ... and its Quality Metrics. + Knowledge of health care delivery system, utilization and review and case review procedures. + Knowledge of Social Determinants… more
- Mount Sinai Health System (New York, NY)
- …patient emergencies and supporting patient-centered care. **Qualifications** Must be a Licensed Registered Nurse , Physician Assistant or Nurse Practitioner ... of Patient Flow experience preferred 5. EPIC experience preferred. Registered Nurse Licensed NYS Registered ...8 hospitals and over 95 inpatient units. Promotes optimum utilization of system hospital beds by conducting rounds and… 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
- Highmark Health (Trenton, NJ)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- RWJBarnabas Health (New Brunswick, NJ)
- …years of progressive management experience in related field preferred Certifications Licenses Registered Nurse RN with valid New Jersey state license required ... for the staff input only, Monitors the allocation and utilization of personnel, based on continual changes in patient...improvement, clinical care delivery processes, and staffing, Assists with review and or revision of policy and procedures as… more
- Mount Sinai Health System (New York, NY)
- …**Licensing and Certification Requirements (if applicable)** + Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions ... in the Daily Management Board process/practice improvement activities to facilitate the utilization of evidence and data related to Nurse Sensitive Indicators… more