- Daiichi Sankyo, Inc. (Bernards, NJ)
- …of nurses working under the general direction of the Regional Director of Clinical Nurse Managers. The OCE is responsible for educating HCPs/clinics with ... plans to meet targeted customer needs.Monitor, collect, and communicate to the Director, Clinical Nurse Manager on customer insights regarding their need for… more
- 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)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… 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
- 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
- RWJBarnabas Health (Somerset, NJ)
- …of experience in the care of the population served, as well as experience in clinical care operations, case management and/or patient throughput + Must have a ... Nurse Coordinator RNReq #:0000220202 Category:Nursing Status:Part-Time Shift:Evening Facility:RWJBarnabas...of care. This position requires securing physician specialist acceptance, clinical assessment, triage for appropriate level of care and… 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
- Centene Corporation (Trenton, NJ)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...Licensed Practical Nurse - State Licensure required or + LVN -… 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
- RWJBarnabas Health (New Brunswick, NJ)
- …1 to 2 weeks in advance for potential conflicts or issues, Patient Care Management Monitors the quality of service and utilization standards and assumes general ... years of related departmental experience required Two years of progressive management experience in related field preferred Certifications Licenses Registered … 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
- RWJBarnabas Health (New Brunswick, NJ)
- …in a clinical area preferred, Experience: 1-3 years relative clinical practice Job Functions: Development/ Management of Personnel Facilitates the safe ... participation in safety/quality initiatives when completing employee performance appraisals Management of Patient Care Delivery Maintains clinical expertise… more
