- Insight Global (Philadelphia, PA)
- …License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review ) Strong computer skills Ability to ... of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer...Previous HEDIS review experience or experience with Utilization Review , Quality, Medical Record auditing Bachelors… more
- Humana (Trenton, NJ)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Fresenius Medical Center (Philadelphia, PA)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Flemington, NJ)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Highmark Health (Trenton, NJ)
- …Highmark Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... + Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN … more
- Humana (Trenton, NJ)
- …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in the state of Virginia or ... licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home… more
- The Cigna Group (Philadelphia, PA)
- The RN Coordinator serves as the key contact point for...as needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for… 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. + A ... great people to join our team. The Acute Care Nurse is responsible for achieving positive patient outcomes, managing...experience required. + A minimum of 1 year of utilization review and/or case management ,… more
- Humana (Trenton, NJ)
- …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
- ChenMed (Philadelphia, PA)
- …with bachelor's degree in home in a related clinical field preferred. + A valid, active Registered Nurse ( RN ) license in State of employment required. + A ... great people to join our team. The Community Care RN ( Nurse Case Manager) is responsible for...with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ;… more
- RWJBarnabas Health (Hamilton, NJ)
- …of Microsoft applications ex. Word ,Excel Preferred: + Utilization review and discharge planning experience + Case Management certification Certifications ... Inpatients to determine appropriateness of continued stay, care planning, utilization management and discharge planning. Required: +...and Licenses Required: + Current license as a registered Nurse in the State of NJ… 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
- Penn Medicine (Plainsboro, NJ)
- …denials in order to avoid non-appealable denials; Credentials: + Registered Nurse - NJ (Required) + National Case Management certification preferred; or ... timely and accurate information to payors. The role integrates and coordinates utilization management , care facilitation and discharge planning functions. In… more
- St. Luke's University Health Network (Allentown, PA)
- …hospital setting required. + Prefer minimum of 2-5 years' experience in case management and/or utilization management . + Prefer financial experience related ... regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and… more
- Penn Medicine (Plainsboro, NJ)
- …to ensure high quality patient care.Credentials:* Basic Cardiac Life Support (Required)* Registered Nurse - NJ (Required)Education:* Bachelor of Arts or Science ... you living your life's work? Summary: We are seeking an experienced and compassionate Nurse **Manager to** lead our nursing team with a commitment to excellence in… more
- Guardian Life (Trenton, NJ)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Penn Medicine (Bala Cynwyd, PA)
- …your life's work? **We are looking for an evening shift Assistant Team Manager RN to oversee our home health operations during the hours of 1:00pm-9:00pm. This ... operations and the provision of care delivery. He/She will review clinical documentation and participate in other quality and...team that includes the following: o Clinical staff case management & direct clinical care o Regulatory compliance o… more
- Sedgwick (Trenton, NJ)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Medicare Compliance **We are growing and looking for nurses who have their ... clinical data; to complete complex submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers for Medicare &… more
- 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...Tissue/Blood banking * Critical care skill set. The chart review is critical, and the candidate must have knowledge… more
- Penn Medicine (Plainsboro, NJ)
- …computer skills with knowledge in Excel, Outlook and EMR.** **Summary:** + The registered nurse /care coordinator will work on a multidisciplinary healthcare team ... and no major holidays. **Must have 5 years of RN experience. Ideal candidate will have care management...receiving appropriate screening and behavioral health interventions. **Credentials:** + Registered Nurse - NJ (Required) **Education or… more