- Elevance Health (Newark, 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
- Hackensack Meridian Health (Hackensack, NJ)
- …and regulatory/payer requirements. The role integrates and coordinates utilization management , care coordination, and discharge planning functions. RN ... with Nursing. **Education, Knowledge, Skills and Abilities Required:** + Case Manager, Registered Nurse Graduate...PC skills. + Current working knowledge of discharge planning, utilization management , case management… more
- RWJBarnabas Health (Newark, NJ)
- …settings. Additionally, candidates must have at least 3 years of recent experience in Case Management , Utilization Review, or Discharge Planning, and a ... federal guidelines and is accountable for case management outcomes as outlined in the Utilization ...+ Current and valid license to practice as a Registered Nurse or Social Worker in the… more
- RWJBarnabas Health (Livingston, NJ)
- Case Manager Registered Nurse ( RN ), Case Management (per diem)Req #:0000191479 Category:Nursing Status:Per Diem Shift:Day Facility:Cooperman ... Job Title: Case Manager Registered Nurse ( RN ), Case Management...hospital setting + Minimum of one year experience in Case Management / Utilization Management … more
- BriteLife Recovery (Englewood, NJ)
- …assigned What we need from you? + Minimum of 2-3 years of experience in utilization review, case management , or insurance coordination in a behavioral health ... compliance. + Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials, approvals,… more
- MVP Health Care (Tarrytown, NY)
- …New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months after hire. + At least 3 years of ... interaction **Your key responsibilities:** + Utilize the essentials of an integrated utilization management and case management model that includes… more
- Mount Sinai Health System (New York, NY)
- …assure timely and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care ... degree preferred + 5 years of Case Management and 6 years as a clinical nurse...New York State + Certification in case management is preferred Non-Bargaining Unit, BEZ - Utilization… more
- RWJBarnabas Health (Rahway, NJ)
- Per Diem Case Manager Registered Nurse ( RN ), Case ManagementReq #:0000183145 Category:Nursing Status:Per Diem Shift:Day Facility:RWJ Rahway ... hospital setting + Minimum of one year experience in Case Management / Utilization Management ...all Orientation Programs Certifications and Licenses Required: + Current Registered Nurse License in the state of… more
- RWJBarnabas Health (Newark, NJ)
- …medical necessity criteria. + Knowledge of state and federal regulations regarding case management , including utilization review, discharge planning, ... + Current and valid license to practice as a Registered Nurse OR Licensed Social Worker in... management skills. + Knowledge of discharge planning, utilization management , case management… more
- CVS Health (Union, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... modules, and field mentoring component. Are you a licensed registered nurse who is passionate about making...Union County New Jersey area. Key Responsibilities: Coordinates all case management activities with members to evaluate… more
- CVS Health (Fair Lawn, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... Qualifications** + Home Health and/or Hospice Experience + LTSS experience + Case management and/or discharge planning experience + Managed Care experience… more
- CVS Health (Kearny, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... Qualifications** + Home Health and/or Home Hospice Experience + LTSS experience + Case management and/or discharge planning experience + Managed Care experience… more
- CVS Health (Union, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... + **MUST have own transportation.** **Preferred Qualifications** + LTSS experience + Case management and/or discharge planning experience + Managed Care… more
- CVS Health (Fairfield, 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
- Mount Sinai Health System (New York, NY)
- **Job Description** ** RN / Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case ... or a minimum of 3-5 years? experience as a RN in an acute care setting. **Licensing and Certification...patients where utilization review, discharge planning, and/or case management will be needed using standardized… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Group Health and Workers' ... disability services for timely return to work. + Provides case management , utilization review, continued...MagnaCare policies and procedures. Essential Qualifications + Currently licensed Registered Nurse in the state of NY,… more
- Atlantic Health System (Morristown, NJ)
- Atlantic Visiting Nurse , part of Atlantic Health System, is seeking a full-time GIP 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
- Mount Sinai Health System (New York, NY)
- …admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve ... Manager (CM) will be responsible for all aspects of case management for an assigned group of...Sinai St. Luke's and Mount Sinai West, BEZ - Utilization Management - WST, Mount Sinai West… more
- Veterans Affairs, Veterans Health Administration (East Orange, NJ)
- Summary The Community Care (CC) Coordinator Registered Nurse ( RN ) is responsible for executing a streamlined approach to receiving, triaging, and directing ... of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Molina Healthcare (New York, NY)
- …authorization requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States...meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience**… more