- 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
- Penn Medicine (Plainsboro, NJ)
- … management of the following areas: Unit Budget Quality Improvement Plan Resource Utilization Human Resource Management Master Unit Staffing Plan Unit Risk ... monitoring in the following areas: Unit Budget Quality Improvement Plan Resource Utilization Human Resource Management Master Unit Staffing Plan Unit Risk… more
- Penn Medicine (Plainsboro, NJ)
- …each day. Are you living your life's work? Summary: + A professional Registered Nurse who is responsible for the direct supervision of nursing staff which is ... by: maintaining open lines ofcommunication with staff, physicians, and management ; providing resource information as requested and overseeing the delivery… 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
- 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
- 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
- CVS Health (Trenton, NJ)
- …research efforts, contributing to scholarly publications, and/or facilitating research utilization to improve clinical care and outcomes. Required Qualifications: ... Registered Nurse (RN) required. Working knowledge of problem solving and...all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit… more
- Highmark Health (Trenton, NJ)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… more
- Sharecare (Trenton, NJ)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Penn Medicine (Plainsboro, NJ)
- …discharge planning and communicates plan clearly to patient, family and Utilization Review Nurse , Financial Counselor and outpatient treatment providers ... interdisciplinary treatment team in a general hospital setting, providing case management and primary psychotherapy with inpatients and outpatients suffering from… 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 year of hire beginning April ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more