- Elevance Health (Hamilton Township, NJ)
- RN Utilization Management - Case Management (Medicaid Long Term Care) JR155671 **Location** : New York or New Jersey. **Virtual:** This role enables ... face-to-face onboarding and skill development as needed. The **Medical Management Nurse ** is responsible for review of...and Experiences:** + A combination of utilization review/ utilization management and Case … more
- St. Luke's University Health Network (Allentown, PA)
- …including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among all ... a patient's ability to pay for health care. The Registered Nurse or Social Worker Care Manager...or obtained within 3 years of hire, MSN and/or Case Management Certification preferred. TRAINING AND EXPERIENCE:… more
- CVS Health (Trenton, NJ)
- …within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers ... reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year...Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- CVS Health (Trenton, NJ)
- …within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers ... reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year...keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator… more
- CVS Health (Moorestown, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... the State training modules, and field mentoring component **Preferred Qualifications** + Case management and/or discharge planning experience + Managed Care… more
- CVS Health (Haddonfield, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... NJ Choice certification is a contingency of employment.** **Preferred Qualifications** + Case management and/or discharge planning experience preferred. + Home… more
- St. Luke's University Health Network (Easton, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Registered Nurse or Social Worker Care Manager is responsible for coordinating the ... the continuum of care. Also works with the providers, registered nurse care managers, social workers, and...including but not limited to: Social workers, assistants, coordinators, utilization management staff, and director. + Facilitates… more
- Penn Medicine (Philadelphia, PA)
- … Nurse - PA (Required) + 5yrs prior experience as a Nurse Case Manager with knowledge of utilization review and 3rd Party Payors (Required) + Pennsylvania ... each day. Are you living your life's work? Job Title: RN Pre Certification Case Manager Department: Business...5+ years Prior experience as a nurse case manager with knowledge of utilization review… more
- Penn Medicine (Philadelphia, PA)
- …assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. Education or ... hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management … more
- AmeriHealth Caritas (Philadelphia, PA)
- …preferred + Minimum of 3 years of experience providing direct patient care;as a Registered Nurse working with medically fragile pediatric patients in a clinical ... setting + Minimum of 3 years of Utilization Management experience, preferably within a managed...such as;InterQual, desired **Licensure** + Current, active, and unrestricted Registered Nurse licensure in Pennsylvania **Skills &… more
- St. Luke's University Health Network (Allentown, PA)
- …an acute care hospital setting required. + Prefer minimum of 2-5 years' experience in case management and/or utilization management . + Prefer financial ... for Medical Necessity and Late-Pick-Up/Notification that are entered by Case Management and Business Office. + Monitors...an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
- Baylor Scott & White Health (Trenton, NJ)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... (2) two years of pertinent experience is essential. + ( RN ) Registered Nurse license and...EXPERIENCE IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** ** Case Management ** ** Utilization Management… more
- ICW Group (Philadelphia, PA)
- …providing direct clinical care required. **CERTIFICATES, LICENSES, REGISTRATIONS** Current unrestricted Registered Nurse ( RN ) or Licensed Vocational ... + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and...Nurse (LVN) required. Certification in case management , rehabilitation nursing or a related… more
- Trinity Health (Pennsauken, NJ)
- …efforts and ensure adherence to all regulatory standards. **Minimum Qualifications:** + Registered Nurse ( RN ) with an active, unencumbered license ... of a disaster will know your disaster recovery, crisis management and business continuity plans and act within your...Involved in the development and implementation of QAPI activities. Nurse Case Manager Page 2 of 4… more
- Highmark Health (Trenton, NJ)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... , identification of opportunities for referral to a Health Coach/ case management , and identification and resolution of...clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS**… more
- Penn Medicine (Philadelphia, PA)
- …advancing their critical thinking skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with ... community resources, and transportation. Quality data collection and risk management referrals. Case management allows...ECIN, shared drive, Internet) + Credentials: Registered Nurse - PA (Required) PA RN Licensure… more
- Trinity Health (Wilmington, DE)
- …current information about the hospital's bed availability + Ensure proper bed utilization and management throughout the hospital. + Assist staff members ... a member of Trinity Health Mid-Atlantic, is looking for an experienced RN Clinical Administrator to join our team!** The Clinical Administrator is responsible… more
- Guardian Life (Bethlehem, PA)
- As the **Clinical Specialist LPN/ RN , Disability Claims** you will perform necessary outreaches to claimants or treating providers to obtain certification dates, ... individual may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed in order to… more
- Sedgwick (Trenton, NJ)
- …and client satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for ... business lines; and to provide expertise in client specific case management and utilization review...promote maximum performance. **QUALIFICATIONS** **Education & Licensing** Current unrestricted RN license in a state or territory of the… more
- St. Luke's University Health Network (Quakertown, PA)
- …concise and timely written and oral communications in the roles of supervisor, professional nurse and RN case manager in the following manner: Demonstrates ... pay for health care. The Clinical Coordinator is a Registered Nurse responsible for the operation of...barotrauma, pneumothorax, and anxiety conditions related to HBOT. Clinical Management - The RN demonstrates clinical managerial… more