- 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
- Hackensack Meridian Health (Brick, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… 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
- 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
- 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
- Hackensack Meridian Health (Neptune City, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Assistant Nurse Manager** is a professional, registered nurse who is a skilled ... to others. The ANM provides operational and administrative support to Nurse leadership. This position effectively coordinates staffing, supports throughput, quality… 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
- 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
- Hackensack Meridian Health (Brick, NJ)
- …expert computer skills. + Familiar with hospital resources, community resources, and utilization management . + Excellent written and verbal communication skills. ... a leader of positive change. The **Care Coordinator, Care Management ** is a member of the healthcare team and...degree. **Licenses and Certifications Required:** + NJ Licensed Registered Nurse or NJ Licensed Social Worker or NJ Licensed… 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
- AristaCare (Manchester, NJ)
- Unit Nurse Manager (RN) AristaCare is seeking a RN Unit Manager to oversee the care management of a population of patients within an assigned area, unit or ... process, assessment, planning, implementation, and evaluation under the scope of the State's Nurse Practice Act of Registered Nurse licensure. The Unit Manager -… more
- Sharecare (Trenton, NJ)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Penn Medicine (Plainsboro, NJ)
- …discharge planning and communicates plan clearly to patient, family and Utilization Review Nurse , Financial Counselor and outpatient treatment providers ... interdisciplinary treatment team in a general hospital setting, providing case management and primary psychotherapy with inpatients and outpatients suffering from… 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 year of hire beginning April ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- Penn Medicine (Plainsboro, NJ)
- …responsive environment. Willdemonstrate responsibility for individual performance and efficient utilization of products, supplies, and equipment. Will utilize time ... specified guidelines and any other audits asassigned by the nurse or nurse manager. + Will participate...to be discharged home as needed. + Practices time management , keeping authorized break periods with accepted policy. Maintains… more
- Penn Medicine (Princeton, NJ)
- …environment. + Will demonstrate responsibility for individual performance and efficient utilization of products, supplies, and equipment. Will utilize time to ensure ... guidelines and any other audits as assigned by the nurse or nurse manager. + Will participate...to be discharged home as needed. + Practices time management , keeping authorized break periods with accepted policy. Maintains… more