- 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
- 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 (Cherry Hill, 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
- 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
- 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)
- …between 8:30a EST and 5:00p EST.** ; + Current, active, and unrestricted Registered Nurse licensure in Pennsylvania. + Associate Degree in Nursing. Bachelor ... 3 years of experience providing direct patient care;as a Registered Nurse working with medically fragile pediatric...a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed… 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
- Virtua Health (Marlton, NJ)
- …Appropriate and complete documentation of individual plan of care in EMR and case management documentation system. Metrics- Accountable to job specific goals, ... clinical nursing ( RN ) experience or Social Work Minimum of 1 year Case Management or other interdisciplinary experience including Homecare Coordination in an… 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
- Sysco (Philadelphia, PA)
- …laws and regulations in the areas of application + Case Management in Workers' Compensation **Licenses/Certifications:** + Licensed Registered Nurse ... employees fit for duty through injury prevention, employee wellness, case management , and process improvement that significantly...Residence. License must be active and unencumbered. + Licensed Registered Nurse in States within the area… more
- Virtua Health (Pennsauken, NJ)
- …and/or certification from the State of New Jersey as a MSW or Registered Nurse . Case Management Certification (requirement within one ... Worker or BSW with a minimum of 5 years experience in case management .Preferred: 3 years clinical nursing ( RN ) experience and 1 year UR/CM/QM experience or… 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 ... Appropriate and complete documentation of individual plan of care in EMR and case management documentation system.* Metrics - Accountable to job specific goals,… more
- Penn Medicine (Bala Cynwyd, PA)
- …nursing teams. Functions monitored will include, but are not limited to, nursing case management , regulatory compliance, direct clinical care, new product and ... service development, and management of Human Resources related items for ...Cardiac Life Support (Required) + Driver's License (Required) + Registered Nurse - PA (Required) + Car… more
- J&J Family of Companies (Horsham, PA)
- …sound, constructive judgment during demanding situations. + **Accountability.** Demonstrates excellent case management skills. Eager to take ownership, be ... will be the certified sites primary day-to-day contact for case -level order management . While you will occasionally...therapy Treatment Center/Site of Care Certification and Activation + RN license or Advanced Practice degree ( Nurse … more
- CVS Health (Trenton, NJ)
- …TOC team will review prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are ... impact on our members, who are enrolled in Care Management and present with a wide range of complex...nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN , the TOC Coach ensures the… more