- Elevance Health (Hamilton Township, NJ)
- RN Utilization Management - Case Management (Medicaid Long Term Care) JR155671 **Location** : New York or New Jersey. **Virtual:** This role enables ... face-to-face onboarding and skill development as needed. The **Medical Management Nurse ** is responsible for review of...and Experiences:** + A combination of utilization review/ utilization management and Case … more
- CVS Health (Trenton, NJ)
- …within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers ... reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year...Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- CVS Health (Trenton, NJ)
- …within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers ... reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year...keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator… more
- CVS Health (Trenton, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... NJ Choice certification is a contingency of employment. **Preferred Qualifications** + Case management and/or discharge planning experience + LTSS experience +… more
- Baylor Scott & White Health (Trenton, NJ)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... (2) two years of pertinent experience is essential. + ( RN ) Registered Nurse license and...EXPERIENCE IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** ** Case Management ** ** Utilization Management… more
- RWJBarnabas Health (New Brunswick, NJ)
- …related to patient evaluation, care, and management , including supervision of RN - nurse coordinators. Your efforts will ensure continuity of care, ... Heart Association (AHA) required + Must be a licensed Registered Nurse in the state of New...Supervise and develop a team of clinical staff, including RN - nurse coordinators, nurse … more
- Highmark Health (Trenton, NJ)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... , identification of opportunities for referral to a Health Coach/ case management , and identification and resolution of...clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS**… more
- US Tech Solutions (Branchburg, NJ)
- … on an **acute/critical care** unit, organ donation/transplant unit, in tissue/blood banking, utilization review and/or case management with critical care ... Schedule - 7:30 am-4:00 pm M-F We need an RN that has at least 5 years' experience in...working in this field in the past year. The RN should have at least 1 of the following… more
- Sedgwick (Trenton, NJ)
- …and client satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for ... business lines; and to provide expertise in client specific case management and utilization review...promote maximum performance. **QUALIFICATIONS** **Education & Licensing** Current unrestricted RN license in a state or territory of the… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Knowledge of evidence-based criteria, utilization review, discharge planning and case management . Licenses and Certifications Required: + NJ State ... Capacity Manager Additional duties as assigned + Collaborates with nurse managers, case managers, physicians, charge nurses,...Professional Registered Nurse License. If you feel that… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Knowledge of evidence-based criteria, utilization review, discharge planning and case management . Licenses and Certifications Required: + NJ State ... and assure continuity of care. Report pertinent information to management and administration. They provide supervision of staff in...Professional Registered Nurse License 166019 Starting at $87,199.84… more
- Virtua Health (Mount Holly, NJ)
- …and/or certification from the State of New Jersey as a MSW or Registered Nurse . Case Management Certification (requirement within one ... Appropriate and complete documentation of individual plan of care in EMR and case management documentation system.* Metrics - Accountable to job specific goals,… more
- J&J Family of Companies (Horsham, PA)
- …sound, constructive judgment during demanding situations. + **Accountability.** Demonstrates excellent case management skills. Eager to take ownership, be ... will be the certified sites primary day-to-day contact for case -level order management . While you will occasionally...therapy Treatment Center/Site of Care Certification and Activation + RN license or Advanced Practice degree ( Nurse … more
- CVS Health (Trenton, NJ)
- …TOC team will review prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are ... impact on our members, who are enrolled in Care Management and present with a wide range of complex...nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN , the TOC Coach ensures the… more
- Penn Medicine (Plainsboro, NJ)
- …but not limited to patient satisfaction, physician satisfaction, LOS, cost per case , discharge disposition, and orthopedic specific outcome tools as necessary. Works ... 16. Maintains a current knowledge of changes in Orthopedic patient care management standards and takes appropriate measures to incorporate into performance systems.… more