- 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Trenton, NJ)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... 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 Appeals and… more
- Lincoln Financial (Trenton, NJ)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Penn Medicine (Plainsboro, NJ)
- … management of the following areas: Unit Budget Quality Improvement Plan Resource Utilization Human Resource Management Master Unit Staffing Plan Unit Risk ... monitoring in the following areas: Unit Budget Quality Improvement Plan Resource Utilization Human Resource Management Master Unit Staffing Plan Unit Risk… more
- Penn Medicine (Plainsboro, NJ)
- …each day. Are you living your life's work? Summary: + A professional Registered Nurse who is responsible for the direct supervision of nursing staff which is ... by: maintaining open lines ofcommunication with staff, physicians, and management ; providing resource information as requested and overseeing the delivery… more
- St. Luke's University Health Network (Quakertown, PA)
- …, including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among all ... regardless of a patient's ability to pay for health care. The Registered Nurse or Social Worker Care Manager is responsible for coordinating the complex discharge… more
- St. Luke's University Health Network (Quakertown, PA)
- …, including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. . Facilitates communication among all ... regardless of a patient's ability to pay for health care. The Registered Nurse or Social Worker Care Manager is responsible for coordinating the complex discharge… 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 ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Atlantic Health System (Basking Ridge, NJ)
- Atlantic 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 ... heavy caseload (up to 4 patients a day); time management skills are essential. However, it is important to...of care for the patient and family Ensures appropriate utilization of services + Maintains visit productivity standards +… more
- CVS Health (Trenton, NJ)
- …identified. - Complete inpatient confinement calls and monitoring for discharge - Management of warm transfers form concierge and engagement hub - Provides clinical ... not limited to: Coordination with -PCP and Specialty providers, Condition Management information and education, Medication management , Community Resources and… more
- St. Luke's University Health Network (Easton, PA)
- …, including but not limited to: Social workers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among ... patient's ability to pay for health care. The Registered Nurse or Social Worker Care Manager is responsible for...obtained within 3 years of hire, MSN and/or Case Management Certification preferred. TRAINING AND EXPERIENCE: Preference is for… 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 ... within the first 6 months of employment. **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
- US Tech Solutions (Branchburg, NJ)
- …on an **acute/critical care** unit, organ donation/transplant unit, in tissue/blood banking, utilization review and/or case management with critical care skill ... set knowledge preferred * CTBS Certified or willing to obtain within two years of employment **Essential Skills, Experience, and Competencies** Understanding & Recognizing (but not limited) the following: * physical assessment findings * history & physical… more
- Highmark Health (Trenton, NJ)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… 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
- Veterans Affairs, Veterans Health Administration (Hamilton, NJ)
- …for assisting the Veterans in providing a smooth process for the management of outpatient appointments. Responsibilities The Advanced Medical Support Assistants are ... as it relates to access to care and clinic management , and will assist with the treatment given to...review the clinics appointment schedule to ensure that clinic utilization is optimized and effectively supports the needs of… more
- Magellan Health Services (Newtown, PA)
- …Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community ... other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided...Social Worker - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care MgmtCare… more
- RWJBarnabas Health (New Brunswick, NJ)
- …80 hours/pay period 2 weeks, 7p-730am, 3 shifts per week in staffing as Charge Nurse with 8hr office day per pay period, Head Nurse assignments vary from ... heart failure, and respiratory failure, The AD is a registered professional nurse who under the direction of the Nursing Director coordinates available resources… more
- RWJBarnabas Health (New Brunswick, NJ)
- …all clinical and administrative operations related to patient evaluation, care, and management , including supervision of RN - nurse coordinators. Your efforts ... New Brunswick campus. In collaboration with the Transplant Division management team, the Clinical Manager, Renal (Kidney/Pancreas) Transplant will...Association (AHA) required + Must be a licensed Registered Nurse in the state of New Jersey + CCTC… more