• RN Utilization Management

    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
    Elevance Health (06/18/25)
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  • Case Manager Registered Nurse

    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 (06/19/25)
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  • Registered Nurse , Case

    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 (06/19/25)
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  • Case Manager Registered Nurse

    CVS Health (Plainfield, NJ)
    …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management ,… more
    CVS Health (06/22/25)
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  • Supervisor, Care Management

    Hackensack Meridian Health (Old Bridge, NJ)
    …acute care setting. + Familiar with hospital resources, community resources, and/or resource/ utilization management . + Care coordination, case management ... leader of positive change. The role of **Supervisor, Care Management ** integrates and coordinates utilization management...Google Suite platforms. **Lice** **nses and Certifications Required:** + Registered Nurse ( RN ) with current… more
    Hackensack Meridian Health (06/06/25)
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  • Case Manager Registered Nurse

    CVS Health (Trenton, 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 + LTSS experience +… more
    CVS Health (06/20/25)
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  • Clinical Case Manager Registered

    CVS Health (Freehold, 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 (06/06/25)
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  • Hospice Registered Nurse - Full…

    Atlantic Health System (Basking Ridge, NJ)
    Atlantic Visiting Nurse , part of Atlantic Health System, is seeking a full-time hospice Registered Nurse to work Monday - Friday from 8 AM to 4 PM in the ... as necessary + Documents patient education tools used Assumes responsibility for Case Management . + Develops/implements/evaluates plan of care based on… more
    Atlantic Health System (05/28/25)
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  • Nurse Educator Generalist Care…

    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
    Baylor Scott & White Health (06/21/25)
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  • Clinical Manager ( RN ) - Renal Transplant

    RWJBarnabas Health (New Brunswick, NJ)
    …related to patient evaluation, care, and management , including supervision of RN - nurse coordinators. Your efforts will ensure continuity of care, ... Heart Association (AHA) required + Must be a licensed Registered Nurse in the state of New...Supervise and develop a team of clinical staff, including RN - nurse coordinators, nurse more
    RWJBarnabas Health (04/12/25)
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  • Care Manager RN

    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
    Highmark Health (06/19/25)
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  • Nurse III

    US Tech Solutions (Branchburg, NJ)
    … on an **acute/critical care** unit, organ donation/transplant unit, in tissue/blood banking, utilization review and/or case management with critical care ... Schedule - 7:30 am-4:00 pm M-F We need an RN that has at least 5 years' experience in...working in this field in the past year. The RN should have at least 1 of the following… more
    US Tech Solutions (04/18/25)
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  • Assistant Vice President

    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
    Sedgwick (05/23/25)
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  • House Supervisor - Psych Nursing - Part-Time…

    Hackensack Meridian Health (Belle Mead, NJ)
    …Knowledge of evidence-based criteria, utilization review, discharge planning and case management . Licenses and Certifications Required: + NJ State ... Capacity Manager Additional duties as assigned + Collaborates with nurse managers, case managers, physicians, charge nurses,...Professional Registered Nurse License. If you feel that… more
    Hackensack Meridian Health (06/20/25)
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  • House Supervisor -Nursing Administration - Per…

    Hackensack Meridian Health (Edison, NJ)
    …milliman and/or interqual criteria, utilization review, discharge planning and case management . Licenses and Certifications Required: 1. NJ State ... a Capacity Manager Additional duties as assigned. Collaborates with nurse managers, case managers, physicians, charge nurses,...Professional Registered Nurse License. 159180 Starting at $59.89… more
    Hackensack Meridian Health (06/20/25)
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  • House Supervisor- Carrier Clinic - P/T…

    Hackensack Meridian Health (Belle Mead, NJ)
    …Knowledge of evidence-based criteria, utilization review, discharge planning and case management . Licenses and Certifications Required: + NJ State ... and assure continuity of care. Report pertinent information to management and administration. They provide supervision of staff in...Professional Registered Nurse License 166019 Starting at $87,199.84… more
    Hackensack Meridian Health (06/20/25)
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  • Transition of Care Associate, Licensed Practical…

    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
    CVS Health (06/01/25)
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  • Orthopedic Patient Navigator

    Penn Medicine (Plainsboro, NJ)
    …but not limited to patient satisfaction, physician satisfaction, LOS, cost per case , discharge disposition, and orthopedic specific outcome tools as necessary. Works ... 16. Maintains a current knowledge of changes in Orthopedic patient care management standards and takes appropriate measures to incorporate into performance systems.… more
    Penn Medicine (06/05/25)
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