- Cooper University Health Care (Camden, NJ)
- …identified populations across the continuum. * Follow established PCC workflow for utilization and self- management support * Participate in PCMH activities which ... more clinical experience, Experience in primary care, population or case management preferred Education Requirements RN , (BSN) preferred License/Certification… more
- CVS Health (Trenton, NJ)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… more
- CVS Health (Trenton, NJ)
- …active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing… more
- CenterWell (Trenton, NJ)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… more
- CVS Health (Trenton, NJ)
- …role** **Must be able to work an Eastern Standard Time schedule** **Must be a licensed RN ** + Utilization Management is a 24/7 operation and the work ... **Required Qualifications** + Must have active, current and unrestricted RN licensure in New Jersey or Compact RN... License + 3+ years of clinical experience + Utilization Management is a 24/7 operation and… more
- St. Luke's University Health Network (Quakertown, PA)
- …including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among all ... we serve, regardless of a patient's ability to pay for health care. The Registered Nurse or Social Worker Care Manager is responsible for coordinating the… 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 ... + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital… more
- Magellan Health Services (Morrisville, PA)
- …Counselor - Care MgmtCare Mgmt, LSW - Licensed Social Worker - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... with necessary degrees: CEAP, LMSW, LCSW, LSW, LPC or RN . Minimum 2 years experience post degree in healthcare,...time management and communication skills. Knowledge of utilization management procedures, mental health and substance… more
- AmeriHealth Caritas (Philadelphia, PA)
- …; **Education/ Experience:;** + Bachelor's degree or equivalent relevant experience + Unrestricted Registered Nurse ( RN ) or Physical Therapist (PT) + Valid ... . **Responsibilities:** Under the supervision of the LTSS Manager/Director for Utilization Management , this position is responsible for providing daily… more
- ChenMed (Philadelphia, PA)
- …We're rapidly expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional ... and assessments within license and as possible given technology and medium. The registered nurse collaborates with primary caregivers and others on the… more
- Centene Corporation (Trenton, NJ)
- …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: ... plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines + Works with… 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 ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Trinity Health (Newtown, PA)
- …overall performance of the team including quality patient care, financial performance, utilization management , and compliance with state and federal regulations. ... and quality standards. Working knowledge in navigating through Excel and utilization of Outlook and Word. Excellent communication and problem-solving skills.… more
- Penn Medicine (Philadelphia, PA)
- …assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. Education or ... hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management … more
- Trinity Health (Philadelphia, PA)
- …required. + Active PA RN License required. + Three (3) years of utilization management or case management experience, including emphasis on discharge ... member of Trinity Health Mid-Atlantic, is seeking an experienced RN Care Manager to join our team in the...planning. + Case Management certification from an accredited organization preferred **We offer… more
- Highmark Health (Trenton, NJ)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- ChenMed (Philadelphia, PA)
- …RN with bachelor's degree in a related clinical field preferred + A valid, active Registered Nurse ( RN ) license in State of employment required + Compact ... the remaining hours. The Acute Care Manager, Complex Care ( RN ) is responsible for achieving positive patient outcomes, managing...required + A minimum of one (1) year of utilization review and/or case management , home health,… more
- Trinity Health (Philadelphia, PA)
- …bonus and day one benefits** **Position Purpose:** The Registered Nurse ( RN ) is responsible for providing oversight and management to the provision of ... participants, at appropriate intervals, at times of status changes Registered Nurse ( RN ) and as...clinicians and caregivers. Responsible for identification of need and utilization of clinical services. **Minimum Qualifications:** + Must be… more
- AristaCare (Philadelphia, PA)
- …under the scope of the State's Nurse Practice Act of Registered Nurse licensure. The Unit Manager - RN coordinates resource utilization , timely and ... RN is reasonable to oversee the care management of a population of patients within an assigned...and regulatory compliance. Requirements; + Must possess, a valid LPN/ Registered Nurse license in the state of… more
- Penn Medicine (Philadelphia, PA)
- …health system organization **Credentials:** + Basic Cardiac Life Support (Required) + Registered Nurse - PA (Required) **Education or Equivalent Experience:** + ... overtime utilization + Assists with the implementation of change management strategies within the practice in alignment with department, entity/Penn Medicine… more
