- Humana (Trenton, NJ)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- VNS Health (Manhattan, NY)
- …and updates through on-going training, coaching and educational materials. + For Utilization Management Only: + Issues Determinations, Notices of Action, and ... advancement opportunities What You Will Do + Conducts comprehensive review of all components related to requests for services...by state or federal regulations are saved in the Utilization Management System. + Reviews, evaluates and… more
- CVS Health (Trenton, NJ)
- …more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... + Clinical experience in post-acute setting + Managed Care experience + Utilization review experience + Experience working with electronic medical record… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- VNS Health (Manhattan, NY)
- …community-based settings. + Manages and evaluates staff in delivery and coordination of utilization management review services in compliance with CMS ... OverviewManages the utilization management team to ensure that...advancement opportunities What You Will Do + Reviews specific utilization issues or requests with Clinical Review … more
- Hackensack Meridian Health (Holmdel, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Molina Healthcare (Manhattan, NY)
- … Review Clinicians with Prior Authorization experience. Experience with Utilization Management (UM) is highly preferred. **KNOWLEDGE/SKILLS/ABILITIES** + ... 3-5 years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred Experience** UM experience highly preferred… more
- Centene Corporation (New York, NY)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Centene Corporation (New York, NY)
- …preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Molina Healthcare (New York, NY)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title: Nurse Practitioner- Heart Hospital-Mount Sinai Hospital- Full Time- Day** A nurse practitioner (NP) as described in Title VIII, ... clinical nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and prescribe for… more
- Mount Sinai Health System (New York, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... clinical nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and prescribe for… more
- NJM Insurance (Trenton, NJ)
- …years of prior experience in clinical nursing (Med-Surg or Critical Care preferred), Utilization Management Review /Hospital concurrent reviews, and/or Case ... comply with all statutory, regulatory, licensing requirements, and NJM policies/guidelines that affect utilization review and medical management work. + Stay… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Case Manager is responsible for all aspects of case management / utilization review for an assigned group of inpatients, ED patients ... new admissions to identify patients where utilization review , discharge planning, and/or case management will...of discharge planning process in collaboration with the clinical nurse initiates the discharge planning process on admission. *… more
- Mount Sinai Health System (New York, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... clinical nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and prescribe for… more
- Penn Medicine (Plainsboro, NJ)
- …managementPatient billing status managementDenials managementCMS Conditions of Participation Utilization review and Discharge planningData collection, auditing ... of the department with direct responsibility of the Care Coordination Nurses ( utilization review and discharge planning). Responsibilities: + Monitors daily… more
- Zufall Health Center (Somerville, NJ)
- Registered Nurse Case Manager Somerville, NJ 08876, USA Req #10615 Wednesday, April 17, 2024 Welcome to Zufall Health! Position Summary The goal of the Medical Case ... Manager (MCM) Nurse is to provide a wide range of client-centered...with program funding policies. The level of medical case management needed by the individual clients is determined by… more
- City of New York (New York, NY)
- …CAS Visiting Psychiatric Services (VPS) Unit is recruiting for two (2) Psychiatric Nurse Practitioner for the roles below. Under the supervision of the Medical ... for independent judgement within NYS licensing guidelines, the VPS Psychiatric Nurse Practitioner is responsible for performing psychiatric evaluations of clients at… more
- Penn Medicine (Plainsboro, NJ)
- … of the following areas: + Quality Improvement Plan + Unit budget + Resource Utilization + Human Resource Management + Master Unit Staffing Plan + Unit Risk ... life's work? Penn Medicine Princeton Health is seeking a Nurse Manager within our Telemetry Unit. This role is... Management + Patient Satisfaction **Essential Job Duties and Responsibilities:**… more
- Elevance Health (Woodbridge, NJ)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... required. **Preferred Skills, Capabilities, and Experiences** **:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more