- 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
- Molina Healthcare (New York, NY)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
- Fresenius Medical Center (New York, NY)
- …and FMS risk management initiatives. + Collaborates with the Clinical Coordinator/Charge RN or Nurse Supervisor to ensure the aggressive treatment of, and ... + Collaborates closely with, providing oversight as needed to, the Clinical Coordinator/Charge RN or Nurse Supervisor acting as nurse manager, the… more
- Fresenius Medical Center (Toms River, NJ)
- …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
- Hackensack Meridian Health (Neptune, NJ)
- …and serve as a leader of positive change. The **Clinical Documentation Specialist Registered Nurse ( RN )** facilitates improvement in the overall quality, ... inpatient admissions and observations as specified by the facility's Utilization Management / Review Committee for documentation...day in the life of a **Clinical Documentation Specialist Registered Nurse ( RN )** at **Hackensack… more
- Fresenius Medical Center (Neptune City, 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)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- FlexStaff (New York, NY)
- …experience in care/case management , disease management , population health management , utilization review , quality assurance, or discharge planning ... intake clinical assessment, reassessment, UAS-NY completion, comprehensive assessment, medication review , and post-hospital discharge evaluation. An ideal candidate would… 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 ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to.... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- Hackensack Meridian Health (Neptune, 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 ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… 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
- RWJBarnabas Health (Long Branch, NJ)
- … License + 3 to 5 years acute care RN experience + Case Management experience Preferred: + Utilization Review or Discharge Planning Experience + Case ... Job Overview: RWJBarnabas Health is seeking a highly dedicated RN to work full time in Case Management... RN to work full time in Case Management for Monmouth Medical Center. Monmouth Medical Center (MMC)… more
- Mount Sinai Health System (New York, NY)
- …to: a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using standardized ... **Job Description** ** RN /Case Manager MSH Case Management FT...Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or… 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
- Erickson Living (Tinton Falls, NJ)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice....care, assisted living or hospital) is required. + Current Registered Nurse license for the state in… more
- RWJBarnabas Health (New Brunswick, NJ)
- …Catheter Lab. The Director of the Cardiac Cath Lab and Physiology departments is a Registered Nurse ( RN ) with the knowledge, skill and competence in the ... Director, Cardiac Catheter Lab ( RN ) - New Brunswick, NJReq #:0000151612 Category:Nursing Manager...and appropriate coverage for operations + Directs all quality review functions and operations in the Department. This includes… more
- Penn Medicine (Plainsboro, NJ)
- …institution Credentials: + Basic Cardiac Life Support (preferred) + Registered Nurse - NJ (Required) + National Case Management certification preferred; or ... (LOC) managementPatient billing status managementDenials managementCMS Conditions of Participation Utilization review and Discharge planningData collection, auditing… more
- Molina Healthcare (New York, NY)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more
- Penn Medicine (Plainsboro, NJ)
- …graduate level education. . **_Related Work Experience_** + Previous experience working as a Registered Nurse . + Unit Budget We believe that the best care ... room, and Congestive Heart Failure Coordinator. This is a registered professional nurse responsible for visioning, overseeing,...+ Quality Improvement Plan + Unit budget + Resource Utilization + Human Resource Management + Master… more
- Mount Sinai Health System (New York, NY)
- …to: 1. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using standardized ... Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or...Sinai St. Luke's and Mount Sinai West, BEZ - Utilization Management - WST, Mount Sinai West… more