- 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
- Trinity Health (Langhorne, PA)
- …Center, a member of Trinity Health Mid-Atlantic, is seeking an experienced Registered Nurse to join our team in Utilization Review! The UM Registered ... population. Facilitates achievement of efficient resource consumption, and acceptable clinical outcomes, through integration and implementation of utilization … 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
- 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 ... 7pm EST approximately 3-4 Thursday and Friday's annually. The Utilization Management Nurse 2 uses clinical...Qualifications** + Minimum of an Associate's degree + Licensed Registered Nurse (RN) with no disciplinary action… 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 ... all with heart, each and every day. Position Summary Utilization Management is a 24/7 operation and work schedules...will include weekends, holidays, and evening hours. * Utilizes clinical experience and skills in a collaborative process to… 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)
- …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 (Trenton, NJ)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- CVS Health (East 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
- Humana (Trenton, NJ)
- …help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation ... Facilities to obtain sufficient clinical information. The Utilization Management Behavioral Health Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) Compact license, with no… more
- Penn Medicine (Plainsboro, NJ)
- …our future each day. Are you living your life's work? Summary: + A professional Registered Nurse who is responsible for the direct supervision of nursing staff ... clinical support Staff rooms as needed Provide resource utilization Provide educational in services related to service line...Nurse Manager follows the standards of the PACU Registered Nurse (Job Code 5028) within the… 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
- Magellan Health Services (Newtown, PA)
- …Care MgmtCare Mgmt, LSW - Licensed Social Worker - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care MgmtCare Mgmt License ... supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of...of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided… 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
- AristaCare (Manchester, NJ)
- …process, assessment, planning, implementation, and evaluation under the scope of the State's Nurse Practice Act of Registered Nurse licensure. The Unit ... Manager - RN coordinates resource utilization , timely and appropriate care interventions, and interdisciplinary communication...and regulatory compliance. Requirements; + Must possess, a valid Registered Nurse license in the state of… more
- AristaCare (Edison, NJ)
- …process, assessment, planning, implementation, and evaluation under the scope of the State's Nurse Practice Act of Registered Nurse licensure. The Unit ... Manager - RN coordinates resource utilization , timely and appropriate care interventions, and interdisciplinary communication...and regulatory compliance. Requirements + Must possess, a valid Registered Nurse license in the state of… more
- AristaCare (South Plainfield, NJ)
- …process, assessment, planning, implementation, and evaluation under the scope of the State's Nurse Practice Act of Registered Nurse licensure. The Unit ... Manager - RN coordinates resource utilization , timely and appropriate care interventions, and interdisciplinary communication...and regulatory compliance. Requirements; + Must possess, a valid Registered Nurse license in the state of… more
- Hackensack Meridian Health (Edison, NJ)
- …Microsoft Office and/or Google Suite platforms. **Lice** **nses and Certifications Required:** + Registered Nurse (RN) with current New Jersey (NJ) License, or ... The role of **Supervisor, Care Management** integrates and coordinates utilization management, care coordination, discharge planning functions and performance… 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