- Trinity Health (Langhorne, PA)
- …seeking an experienced Registered Nurse to join our team in Utilization Review ! The UM Registered Nurse is responsible for the coordinating and ... + CCM or Accredited Case Manager certification preferred. + Previous experience in Utilization review highly preferred. + Demonstrates ability to use problem… more
- Cognizant (Trenton, NJ)
- …Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- Humana (Trenton, NJ)
- …SRO **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The… more
- Atlantic Health System (Basking Ridge, NJ)
- …Visiting Nurse , part of Atlantic Health System, is seeking a full-time hospice Registered Nurse to work 8AM- 4PM in the Somerset County area, including ... of care for the patient and family Ensures appropriate utilization of services + Maintains visit productivity standards +...Program- Associates Degree 2. Current state licensure as a Registered Nurse . 3. BLS certification. Preferred: 1.… more
- Humana (Trenton, NJ)
- …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) Compact license, with no disciplinary action + 3 ... caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes...Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation… more
- Humana (Trenton, NJ)
- …**Use your skills to make an impact** **Required Qualifications** + **Active Registered Nurse (RN) Multi-state/Compact State license with no disciplinary ... caring community and help us put health first** The Nurse Advice Line is a fast-paced inbound call center...Bachelor's degree in nursing (BSN) + Previous case management, utilization review , or triage experience + Previous… more
- Sharecare (Trenton, NJ)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Datavant (Trenton, NJ)
- …with 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...by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
- RWJBarnabas Health (New Brunswick, NJ)
- …years of progressive management experience in related field preferred Certifications Licenses Registered Nurse RN with valid New Jersey state license required ... for the staff input only, Monitors the allocation and utilization of personnel, based on continual changes in patient...improvement, clinical care delivery processes, and staffing, Assists with review and or revision of policy and procedures as… more
- Highmark Health (Trenton, NJ)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Knowledge, Skills and Abilities Preferred: + Knowledge of evidence-based criteria, utilization review , discharge planning and case management. Licenses and ... Certifications Required: + NJ State Professional Registered Nurse License. 172368 Minimum rate of $112,114.08 Annually HMH is committed to pay equity and… more