- Baylor Scott & White Health (Trenton, NJ)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- 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
- 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
- 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
- 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
- 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
- Trinity Health (Philadelphia, PA)
- …**Description:** Nazareth Hospital, a member of Trinity Health Mid-Atlantic, is seeking experienced Utilization Management RN to join the Case Management ... general supervision of the Manager of Utilization Management , the Utilization RN assists...all aspects of reimbursement as related to the clinical review and level of care. Management of… 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
- 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)
- …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
- 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
- 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 (Philadelphia, PA)
- …+ Manage pay practices including accurate time card review and approval, review and manage all overtime utilization + Assists with the implementation of ... special clinical programs, multiple clinical specialties, complex regulatory requirements, management of external partnerships/collaborations. Responsibilities: + Demonstrates how their… more
- CVS Health (Trenton, NJ)
- …state of New Jersey as one of the following: Licensed Clinical Social Worker (LCSW), Registered Nurse ( RN ), Clinical Nurse Specialist (CNS), Licensed ... + 4+ years demonstrated experience in managed care Utilization Management to include prior authorization, concurrent review OR demonstrated experience… more
- Penn Medicine (Philadelphia, PA)
- …(Outlook, Canopy, CERME, ECIN, shared drive, Internet) + Credentials: Registered Nurse - PA (Required) PA RN Licensure required. Education or Equivalent ... fearful you will miss patient contact? If so, our nurse case manager role at Penn Medicine is the...being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, team,… 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
- Hackensack Meridian Health (Belle Mead, NJ)
- …Preferred: + Knowledge of milliman and/or interqual criteria, utilization review , discharge planning and case management Licenses and Certifications ... and assure continuity of care. Report pertinent information to management and administration. They provide supervision of staff in...Required: + NJ State Professional Registered Nurse License **Job ID** _2024-158657_ **Department**… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Preferred: + Knowledge of milliman and/or interqual criteria, utilization review , discharge planning and case management Licenses and Certifications ... and assure continuity of care. Report pertinent information to management and administration. They provide supervision of staff in...Required: + NJ State Professional Registered Nurse License **Job ID** _2024-157926_ **Department**… more
- CVS Health (Trenton, NJ)
- …visit, inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN , the TOC Coach ensures the member experiences a ... impact on our members, who are enrolled in Care Management and present with a wide range of complex...or changes in condition to be transitioned back to RN . + Complete post discharge call and required assessments… more