- Humana (Trenton, NJ)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (Trenton, NJ)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… more
- AmeriHealth Caritas (Philadelphia, PA)
- …pediatric patients in a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization. + Experience ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Humana (Trenton, NJ)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Zurich NA (Trenton, NJ)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… 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 ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- ChenMed (Philadelphia, PA)
- …with guidelines. This position may require participation in risk and quality management programs, clinical meetings and other meetings.The Nurse Practitioner ... ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as required that promote… more
- CVS Health (Trenton, NJ)
- …You can have life-changing impact on our members, who are enrolled in Care Management and present with a wide range of complex health and social challenges. With ... exciting opportunity as we grow and expand our Care Management Programs to change lives in new markets across...timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department … more
- Insight Global (Philadelphia, PA)
- …Active RN License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review) Strong computer skills Ability ... abstraction & entry of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer equipment, encrypted zip drives… more
- Penn Medicine (Plainsboro, NJ)
- …of care with attention to continuity across shifts and settings. The Registered Nurse will assure communication between patients, families and all members of the ... health care team. The Registered Nurse delegates and functions in accordance with the NJ...allocated funds. * Utilize personnel efficiently and assure cost-effective utilization of supplies. * Interprets and effects administrative policy… more
- Sharecare (Trenton, NJ)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Trinity Health (Pennsauken, NJ)
- …behavior. 10. In light of a disaster will know your disaster recovery, crisis management and business continuity plans and act within your role that is developed ... Committee if required. Involved in the development and implementation of QAPI activities. Nurse Case Manager Page 2 of 4 15. Coordinate hospital discharges in… more
- ChenMed (Philadelphia, PA)
- …expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional patient care advice ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- ChenMed (Philadelphia, PA)
- …expanding and we need great people to join our team. The Registered Nurse , Telehealth is responsible for providing telephonic triage directional patient care advice ... issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. The incumbent in this role… more
- Penn Medicine (Plainsboro, NJ)
- …you living your life's work? Summary: We are seeking an experienced and compassionate Nurse **Manager to** lead our nursing team with a commitment to excellence in ... patient care and staff development. The Nurse Manager is responsible for overseeing daily operations, ensuring quality and safety standards, managing staff… more
- Highmark Health (Trenton, NJ)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … 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 ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Penn Medicine (Bala Cynwyd, PA)
- …Functions monitored will include, but are not limited to, nursing case management , regulatory compliance, direct clinical care, new product and service development, ... and management of Human Resources related items for RN staff...that all regulatory requirements are met. + Ensures effective utilization of materials, staff, and financial resources. + Sponsors… more
- CVS Health (Moorestown, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... be responsible for, care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. Strong assessment,… more
- Fresenius Medical Center (Willow Grove, PA)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more