- Evolent (Trenton, NJ)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Actalent (New Brunswick, NJ)
- Job Title: Clinical Research Nurse Job Description The...active cancer patients for clinical trials. + Review patient charts and medical history to ... ensure the successful, patient-oriented, safe, and effective conduct of clinical trials. The Clinical Research Nurse...using the study start-up task list. + Prepare and review study tools such as study binders, medication diaries,… more
- Cognizant (Trenton, NJ)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. . Medical Necessity Reviews can… more
- Fresenius Medical Center (Somerset, NJ)
- **PURPOSE AND SCOPE:** The professional registered nurse Outpatient RN CAP 2 may be an entry level designation into the Clinical Advancement Program (CAP) for ... functions under the direction of the Supervisor and with guidance from the Clinical Educator, Preceptor or in collaboration with other Registered Nurses. + Performs… more
- Centene Corporation (Trenton, NJ)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- Penn Medicine (Plainsboro, NJ)
- …shape our future each day. Are you living your life's work? Summary: + The Clinical Nurse 2 Colleague possesses the knowledge, skills and the attitude to ... the field of medicine. Working for this leading academic medical center means collaboration with top clinical ,...for competent professional nursing practice as specified in the Clinical Nurse 2 position description. The … more
- Penn Medicine (Plainsboro, NJ)
- …shape our future each day. Are you living your life's work? Summary: + The Clinical Nurse 2 Colleague possesses the knowledge, skills and the attitude to ... the field of medicine. Working for this leading academic medical center means collaboration with top clinical ,...for competent professional nursing practice as specified in the Clinical Nurse 2 position description. The … more
- Penn Medicine (West Windsor, NJ)
- …meet standards for competent professional nursing practice as specified in the Clinical Nurse 2 position description. Exhibits PMPH organizational behavioral ... the field of medicine. Working for this leading academic medical center means collaboration with top clinical ,...competency in all Knowledge, Skills and Attitudes for a Clinical Nurse 1 in addition to: b.… more
- Gentiva (Trevose, PA)
- …(LCD) criteria per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and ... **Overview** **Expand Access. Build Partnerships. Transform Hospice Care.** ** Nurse Practitioner - NP - Hospice - PRN - Flexible Schedule** We are seeking a… more
- Hunterdon Health Care System (Flemington, NJ)
- Position Summary The Advanced Practice Nurse is responsible for the day to day coordination and oversight of the clinical management of assigned patients in the ... Assessment Program, nursing homes and sub-acute facilities. The Advanced Practice Nurse functions independently, while also collaborating with the interdisciplinary … more
- Veterans Affairs, Veterans Health Administration (Lyons, NJ)
- … Center. Responsibilities VA Careers - Licensed Practical Nurse : https://youtube.com/embed/Ae85IP1Oiz4 Licensed Practical Nurse - ... and record relevant patient information. Completed work should need only a general review by a registered nurse or physician for appropriateness and conformity… more
- Redeemer Health Home Care & Hospice (Langhorne, PA)
- …on written and/or electronic communication and review of the electronic medical record. He/She utilizes clinical judgment, knowledge, critical thinking and ... coordination for patients upon discharge from a hospital or medical facility, and pre-visit triage to include the identification...clinical condition and testing results. The PCP office nurse serves as a liaison, educator, health counselor, and… more
- CVS Health (Trenton, NJ)
- …benefit overall claim management. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to ... in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993,… more
- CVS Health (Trenton, NJ)
- …criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review . + Conduct clinical reviews via phone and electronic ... Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care… more
- Sunrise Senior Living (Bridgewater, NJ)
- …NAME** Sunrise of Bridgewater **Job ID** 2025-233816 **JOB OVERVIEW** The Wellness Nurse is responsible for monitoring the health and well-being of our residents ... administration, communication with resident support services and families and maintaining clinical quality assurance while leading and demonstrating the Mission for… more
- AristaCare (South Plainfield, NJ)
- Registered Nurse The primary purpose of your job position is to coordinate care on nursing units in accordance with federal and state guidelines, as well as in ... facility established policies and procedures. The position provides administrative supervision and clinical oversight to the unit on all shifts to assure that… more
- Hackensack Meridian Health (Edison, NJ)
- …for coordinating, communicating and facilitating the care of patients with Medical , Behavioral and Maternal Health needs. The navigator is accountable for ... be based within our Northern Region, covering Hackensack University Medical Center and Palisades Medical Center. **Education,...+ Knowledge of health care delivery system, utilization and review and case review procedures. + Knowledge… more
- Surgery Care Affiliates (Watchung, NJ)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… more
- Surgery Care Affiliates (Langhorne, PA)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… more
- Prime Healthcare (Bristol, PA)
- …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, ... community hospital, serving the Lower Bucks County region with medical , surgical, and emergency care. Located in historic Bristol,...accredited school of nursing and a current state Registered Nurse license + Grandfathered prior to April 1, 2015.… more