- Organon & Co. (Plymouth Meeting, PA)
- **Job Description** **The Position** The Women's Health Clinical Account Specialist (WHCAS) supports customers by providing clinical information on our Company's ... products, as well as education, and supporting clinical training programs. They do this to support customer needs, to help the provider or system meet the goals of… more
- CVS Health (Trenton, NJ)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Trenton, NJ)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... 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 … more
- CVS Health (Trenton, NJ)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- CVS Health (Trenton, NJ)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Penn Medicine (Philadelphia, PA)
- …The Integrated Clinical Nurse Manager is responsible for assisting clinical and administrative leadership with the management of practice and operations ... life's work? Summary: + The role of the Integrated Clinical Nurse Manager is an integrated role...for staffing, regulatory compliance, employee performance management , clinical education and competency, capacity utilization , and… more
- Evolent (Trenton, NJ)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Virtua Health (Marlton, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... Locations: Job Information: *Current board certification as WOC (ET) nurse (CWOCN) by the Wound, Ostomy and Continence Nursing...determine the types of services to be provided. Case management nurses provide education in disease management … more
- Sharecare (Trenton, NJ)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- ChenMed (Philadelphia, PA)
- …position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty incumbent ... of practice + A minimum of 3 years experience working in Cardiology as a Nurse Practitioner in an out-patient clinical setting + Basic Life Support (BLS)… 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 ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Veterans Affairs, Veterans Health Administration (Philadelphia, PA)
- …promotion, health education and coaching on wellness, disease prevention, and chronic care management . The nurse will assist in directing the provision of ... providing compassionate whole health care to Veterans? Responsibilities The Registered Nurse (RN) - Endoscopy is responsible for providing competent, evidence-based… more
- Highmark Health (Trenton, NJ)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Penn Medicine (Philadelphia, PA)
- …Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn ... life's work? TheHospital of the University of Pennsylvania (HUP)is seeking an _Assistant Nurse Manager_ to join the _Labor & Delivery (Ravdin 7) team!_ These honors… more
- Virtua Health (Marlton, NJ)
- …Program Director, and Palliative Care and Hospice Team members to assure that clinical protocols, utilization review, case management , quality assurance, and ... in knowledge and practice in Palliative and Hospice Care. Collaborates with clinical pharmacy around medication management . Assures coverage for medical… 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 ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today...candidate for this position must be a seasoned med/surg nurse with a minimum of 5 years' experience in… more
- Centene Corporation (Trenton, NJ)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...Licensed Practical Nurse - State Licensure required or + LVN -… more
- Penn Medicine (Cherry Hill, NJ)
- …staff for the practice, orients new hires, and maintains competencies of clinical staff, performance management , staff development, accurately records time ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- ChenMed (Philadelphia, PA)
- …in a related clinical field preferred + A valid, active Registered Nurse (RN) license in State of employment required + Compact License preferred for states ... through external providers and healthcare systems. The Acute Care Nurse is an important member of the Complex Care...required + A minimum of one (1) year of utilization review and/or case management , home health,… more
