- Elevance Health (Hamilton Township, NJ)
- RN Utilization Management - Case Management (Medicaid Long Term Care) JR155671 **Location** : New York or New Jersey. **Virtual:** This role enables ... face-to-face onboarding and skill development as needed. The **Medical Management Nurse ** is responsible for review of...and Experiences:** + A combination of utilization review/ utilization management and Case … more
- CVS Health (Trenton, NJ)
- …within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers ... reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year...Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- CVS Health (Trenton, NJ)
- …within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers ... reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year...keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator… more
- CVS Health (Trenton, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... NJ Choice certification is a contingency of employment. **Preferred Qualifications** + Case management and/or discharge planning experience + LTSS experience +… more
- CVS Health (Moorestown, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... the State training modules, and field mentoring component **Preferred Qualifications** + Case management and/or discharge planning experience + Managed Care… more
- Baylor Scott & White Health (Trenton, NJ)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... (2) two years of pertinent experience is essential. + ( RN ) Registered Nurse license and...EXPERIENCE IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** ** Case Management ** ** Utilization Management… more
- Trinity Health (Pennsauken, NJ)
- …efforts and ensure adherence to all regulatory standards. **Minimum Qualifications:** + Registered Nurse ( RN ) with an active, unencumbered license ... of a disaster will know your disaster recovery, crisis management and business continuity plans and act within your...Involved in the development and implementation of QAPI activities. Nurse Case Manager Page 2 of 4… more
- Highmark Health (Trenton, NJ)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... , identification of opportunities for referral to a Health Coach/ case management , and identification and resolution of...clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS**… more
- Sedgwick (Trenton, NJ)
- …and client satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for ... business lines; and to provide expertise in client specific case management and utilization review...promote maximum performance. **QUALIFICATIONS** **Education & Licensing** Current unrestricted RN license in a state or territory of the… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Knowledge of evidence-based criteria, utilization review, discharge planning and case management . Licenses and Certifications Required: + NJ State ... Capacity Manager Additional duties as assigned + Collaborates with nurse managers, case managers, physicians, charge nurses,...Professional Registered Nurse License. If you feel that… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Knowledge of evidence-based criteria, utilization review, discharge planning and case management . Licenses and Certifications Required: + NJ State ... and assure continuity of care. Report pertinent information to management and administration. They provide supervision of staff in...Professional Registered Nurse License 166019 Starting at $87,199.84… more
- Virtua Health (Pennsauken, NJ)
- …and/or certification from the State of New Jersey as a MSW or Registered Nurse . Case Management Certification (requirement within one ... Worker or BSW with a minimum of 5 years experience in case management .Preferred: 3 years clinical nursing ( RN ) experience and 1 year UR/CM/QM experience or… more
- Virtua Health (Mount Holly, NJ)
- …and/or certification from the State of New Jersey as a MSW or Registered Nurse . Case Management Certification (requirement within one ... Appropriate and complete documentation of individual plan of care in EMR and case management documentation system.* Metrics - Accountable to job specific goals,… more
- J&J Family of Companies (Horsham, PA)
- …sound, constructive judgment during demanding situations. + **Accountability.** Demonstrates excellent case management skills. Eager to take ownership, be ... will be the certified sites primary day-to-day contact for case -level order management . While you will occasionally...therapy Treatment Center/Site of Care Certification and Activation + RN license or Advanced Practice degree ( Nurse … more
- CVS Health (Trenton, NJ)
- …TOC team will review prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are ... impact on our members, who are enrolled in Care Management and present with a wide range of complex...nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN , the TOC Coach ensures the… more
- Virtua Health (Pennsauken, NJ)
- …Appropriate and complete documentation of individual plan of care in EMR and case management documentation system. Metrics- Accountable to job specific goals, ... clinical nursing ( RN ) experience or Social Work Minimum of 1 year Case Management or other interdisciplinary experience including Homecare Coordination in an… more
- Penn Medicine (Plainsboro, NJ)
- …but not limited to patient satisfaction, physician satisfaction, LOS, cost per case , discharge disposition, and orthopedic specific outcome tools as necessary. Works ... 16. Maintains a current knowledge of changes in Orthopedic patient care management standards and takes appropriate measures to incorporate into performance systems.… more