- CVS Health (Trenton, NJ)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… more
- CVS Health (Trenton, NJ)
- …active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing… more
- Humana (Trenton, NJ)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- US Tech Solutions (Hopewell, NJ)
- …**Additional licensing, certifications, registrations:** 1. Requires an active New Jersey Registered Nurse License. **Knowledge:** - Prefers proficiency in the ... case/care management principles. - Prefers working knowledge of principles of utilization management . - Prefers basic knowledge of health care contracts and… more
- Cognizant (Trenton, NJ)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Trenton, NJ)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… more
- CVS Health (Trenton, NJ)
- …**Must be able to work an Eastern Standard Time schedule** **Must be a licensed Registered Nurse , any compact licensure must cover New Jersey** + Utilization ... **Required Qualifications** + Must have active, current and unrestricted RN licensure in New Jersey or Compact RN... License + 3+ years of clinical experience + Utilization Management is a 24/7 operation and… more
- CVS Health (Riverton, NJ)
- …new hires upon achieving proficiency in the role. **Required Qualifications** + Active, unrestricted ** Registered Nurse ( RN ) license in New Jersey** . + ... high-quality, cost-effective care for our members. These strategies encompass utilization management , quality improvement, network coordination, and clinical… more
- CVS Health (Trenton, NJ)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating… more
- ChenMed (Philadelphia, PA)
- …We're rapidly expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional ... and assessments within license and as possible given technology and medium. The registered nurse collaborates with primary caregivers and others on the… more
- Fresenius Medical Center (Wilmington, DE)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... of education and experience. + Graduate of an accredited School of Nursing ( RN ). + Current appropriate state licensure. **EXPERIENCE AND SKILLS:** + Required: + 6+… more
- AmeriHealth Caritas (Philadelphia, PA)
- …; **Education/ Experience:;** + Bachelor's degree or equivalent relevant experience + Unrestricted Registered Nurse ( RN ) or Physical Therapist (PT) + Valid ... . **Responsibilities:** Under the supervision of the LTSS Manager/Director for Utilization Management , this position is responsible for providing daily… more
- Centene Corporation (Trenton, NJ)
- …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: ... plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines + Works with… more
- Trinity Health (Newtown, PA)
- …overall performance of the team including quality patient care, financial performance, utilization management , and compliance with state and federal regulations. ... and quality standards. Working knowledge in navigating through Excel and utilization of Outlook and Word. Excellent communication and problem-solving skills.… more
- Penn Medicine (Philadelphia, PA)
- …assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. Education or ... candidate for this position must be a seasoned med/surg nurse with a minimum of 3 to 5 years...community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management… more
- Highmark Health (Trenton, NJ)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- St. Luke's University Health Network (Sellersville, PA)
- …including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among all ... patient populations across the continuum of care. Also works with the providers, registered nurse care managers, and multi-disciplinary care teams to facilitate… more
- Penn Medicine (Philadelphia, PA)
- …assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. Education or ... hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management … more
- Trinity Health (Philadelphia, PA)
- …required. + Active PA RN License required. + Three (3) years of utilization management or case management experience, including emphasis on discharge ... member of Trinity Health Mid-Atlantic, is seeking an experienced RN Care Manager to join our team in the...planning. + Case Management certification from an accredited organization preferred **We offer… more
- ChenMed (Philadelphia, PA)
- …RN with bachelor's degree in a related clinical field preferred + A valid, active Registered Nurse ( RN ) license in State of employment required + Compact ... the remaining hours. The Acute Care Manager, Complex Care ( RN ) is responsible for achieving positive patient outcomes, managing...required + A minimum of one (1) year of utilization review and/or case management , home health,… more