- CVS Health (Trenton, NJ)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Trenton, NJ)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- CVS Health (Trenton, NJ)
- … (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all ... and state regulated turn-around times. This includes reviewing written clinical records. **Key Responsibilities of the UM Nurse...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- US Tech Solutions (Hopewell, NJ)
- …case/care management principles. - Prefers working knowledge of principles of utilization management . - Prefers basic knowledge of health care contracts and ... duties and types of care management as assigned by management .** **Responsibilities:** 1. Assesses patient's clinical need against established guidelines… more
- CVS Health (Trenton, NJ)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Trenton, NJ)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Hackensack Meridian Health (Edison, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Evolent (Trenton, NJ)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Sharecare (Trenton, NJ)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Penn Medicine (Plainsboro, NJ)
- …DepartmentsProvide clinical support Staff rooms as needed Provide resource utilization Provide educational in services related to service line Direct and assist ... development by planning and implementing annual goals and objectives, in conjunction with Nurse Manager's input, to assure maintenance of clinical competency and… more
- CVS Health (Trenton, NJ)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Highmark Health (Trenton, NJ)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Evolent (Trenton, NJ)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Hackensack Meridian Health (Edison, NJ)
- …serve as a leader of positive change. The role of **Supervisor, Care Management ** integrates and coordinates utilization management , care coordination, ... acute care setting. + Familiar with hospital resources, community resources, and/or resource/ utilization management . + Care coordination, case management or… more
- Highmark Health (Trenton, NJ)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... requirements. Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures, including review… more
- Hackensack Meridian Health (Edison, NJ)
- …expert computer skills. + Familiar with hospital resources, community resources, and utilization management . + Excellent written and verbal communication skills. ... and serve as a leader of positive change. The **Care Coordinator, Care Management ** is a member of the healthcare team and is responsible for coordinating,… more
- Penn Medicine (Plainsboro, NJ)
- …treatment plan reviews within established timeframes + Communicate effectively the essential clinical features of each case with utilization reviewers and ... discharge planning and communicates plan clearly to patient, family and Utilization Review Nurse , Financial Counselor and outpatient treatment providers… more
- Sharecare (Trenton, NJ)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- J&J Family of Companies (New Brunswick, NJ)
- …and business needs. The Sr. MSL is considered an established scientific and clinical knowledge lead on current and future J&J Innovative Medicine products per ... will continue to enhance their skills in agility, applying the competencies of Change Management , Time Management and Innovation. The Sr. MSL is responsible for… more
- AristaCare (Edison, NJ)
- Unit Manager The unit manager will be responsible for overseeing the care management of a population of patients within an assigned area, unit or clinical ... process, assessment, planning, implementation, and evaluation under the scope of the State's Nurse Practice Act of Registered Nurse licensure. The Unit Manager -… more