- 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 (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
- 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
- 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
- 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)
- …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
- 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
- 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
- RWJBarnabas Health (Somerset, NJ)
- …Required: + Graduate of an approved school of nursing + New Jersey Professional Registered Nurse License + Valid Driver's License from a USA state + ... and Licenses Required: + Requires a New Jersey Professional Registered Nurse License + Valid Driver's License...and assesses the use of hospital services by administering utilization review procedures under Federal, State and… more
- Hackensack Meridian Health (Edison, NJ)
- …expert computer skills. + Familiar with hospital resources, community resources, and utilization management . + Excellent written and verbal communication skills. ... or meetings. + Identifies and refers quality issues for review to the Quality Management Program. +...Master's degree. **Licenses and Certifications Required:** + NJ Licensed Registered Nurse or NJ Licensed Social Worker… 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** _2024-157872_ **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