- Organon & Co. (Plymouth Meeting, PA)
- …include Health Care Providers such as Physicians across multiple specialties, Nurse Practitioners, Physician Assistants, Midwives, Nurses and Pharmacist in addition ... programs, Federally Qualified Health Centers, Universities, Independent Physician Associations, Management Service Organizations, Planned Parenthood and Family Planning Clinics,… more
- Humana (Trenton, NJ)
- …a part of our caring community and help us put health first** The Weekend 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
- 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
- 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
- CVS Health (Trenton, NJ)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Sharecare (Trenton, NJ)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- ICW Group (Philadelphia, PA)
- …AND SKILLS** Understanding of Workers' Compensation, Workers' Compensation Managed Care processes, Utilization Review, Telephonic Nurse Case Management , and ... **ESSENTIAL DUTIES AND RESPONSIBILITIES** Provides oversight for all vended Nurse Case Management (NCM) products, including Field... management issues related to bill review, case management and utilization review. + Works closely… 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
- ChenMed (Philadelphia, PA)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty incumbent adheres to strict departmental goals/objectives, standards ... we need great people to join our team. The Nurse Practitioner (NP), Specialty acts as part of the...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… more
- Penn Medicine (Philadelphia, PA)
- …have direct responsibility for staffing, regulatory compliance, employee performance management , clinical education and competency, capacity utilization , and ... you living your life's work? Summary: + The role of the Integrated Clinical Nurse Manager is an integrated role within the Oncology service line/Cancer Service Line… 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
- 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
- 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 ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Elevance Health (Wilmington, DE)
- …The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager Senior** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and… more
- Elevance Health (Wilmington, DE)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more
- Penn Medicine (Philadelphia, PA)
- …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 ... Obstetric Anesthesia and Perinatology Center of Excellence Award Summary: + Assists Nurse Manager by assuming 24-hour accountability for the operation of the… 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
- Virtua Health (Marlton, NJ)
- …Palliative Care and Hospice Team members to assure that clinical protocols, utilization review, case management , quality assurance, and compliance Programs are ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
