- Cognizant (Trenton, NJ)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... 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
- 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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state)… more
- CVS Health (Trenton, NJ)
- …both verbal and written **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active ... work schedules will include weekends, holidays, and evening hours._ + Utilizes clinical experience and skills in a collaborative process to assess, plan, implement,… more
- US Tech Solutions (Hopewell, NJ)
- …**Additional licensing, certifications, registrations:** 1. Requires an active New Jersey Registered Nurse License. **Knowledge:** - Prefers proficiency in the ... care management as assigned by management.** **Responsibilities:** 1. Assesses patient's clinical need against established guidelines and/or standards to ensure that… 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 ... in New Jersey or Compact RN License + 3+ years of clinical experience + Utilization Management is a 24/7 operation and work schedule may include weekends,… more
- CVS Health (Trenton, NJ)
- …good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC (Licensed Associate ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult inpatient… more
- CVS Health (West Windsor, NJ)
- …hires upon achieving proficiency in the role. **Required Qualifications** + Active, unrestricted ** Registered Nurse (RN) license in New Jersey** . + Minimum of ... high-quality, cost-effective care for our members. These strategies encompass utilization management, quality improvement, network coordination, and clinical … more
- Centene Corporation (Trenton, NJ)
- …+ LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: $26.50 - $47.59 per hour Centene ... 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,… more
- CVS Health (Trenton, NJ)
- …a member's overall wellness through integration. - Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and ... functions as well as smooth transition to programs and plans. - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and… more
- Sharecare (Trenton, NJ)
- …to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they… more
- Hackensack Meridian Health (Edison, NJ)
- …systems; Google Docs, EPIC. **Licenses and Certifications Required** : + NJ State Professional Registered Nurse License. + AHA Basic Health Care Life Support HCP ... program and its Quality Metrics. + Knowledge of health care delivery system, utilization and review and case review procedures. + Knowledge of Social Determinants of… more
- Datavant (Trenton, NJ)
- …clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- Penn Medicine (Plainsboro, NJ)
- …proactively identify potential denials in order to avoid non-appealable denials; **Credentials:** + Registered Nurse - NJ (Required) + Certified Case Manager + ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- Highmark Health (Trenton, NJ)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …and case management. Licenses and Certifications Required: + NJ State Professional Registered Nurse License. 172368 Minimum rate of $112,114.08 Annually HMH ... HMH values, leadership and interpersonal skills to oversee the clinical and leadership functions of the Medical Center in...delivery of care for patients and serve as a clinical resource. They assume the leadership position for Incident… more
- Hackensack Meridian Health (Edison, NJ)
- …planning and case management. Licenses and Certifications Required: 1. NJ State Professional Registered Nurse License. 169637 Minimum rate of $59.89 Hourly HMH ... JFK values, leadership and interpersonal skills to oversee the clinical and leadership functions of the Medical Center in...delivery of care for patient and serves as a clinical resource. He/she assumes the leadership position for Incident… more
- Penn Medicine (Plainsboro, NJ)
- …Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn ... to, performing and assisting in various. Quality Assurance procedures (ie: clinical warm-up procedures, billing, etc.); participating in nursing and follow-up care,… more
- Hackensack Meridian Health (Edison, NJ)
- …Abilities Preferred:** + Master's degree. **Licenses and Certifications Required:** + NJ Licensed Registered Nurse or NJ Licensed Social Worker or NJ Licensed ... team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment and discharge plan. Accountable for… more