- 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
- 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
- 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
- Chatham Hills Subacute Care Center (Chatham, NJ)
- …meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training ... a week 37.5 - 40 hours per week Respiratory Nurse (RN) We are searching for a highly motivated,...communications within the facility with the director of nursing, nurse managers, and admissions coordinator to assist in development… 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
- Fresenius Medical Center (Staten Island, NY)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… 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 (Long Island City, NY)
- …REQUIREMENTS** Licensure: New York State License with current registration as a registered nurse . State Certification: Certified by the New York State ... as follows: a.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
- 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
- Humana (Trenton, NJ)
- …**Use your skills to make an impact** **Required Qualifications** + **Active Registered Nurse (RN) Multi-state/Compact State license with no disciplinary ... caring community and help us put health first** The Nurse Advice Line is a fast-paced inbound call center...Bachelor's degree in nursing (BSN) + Previous case management, utilization review , or triage experience + Previous… 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