- Hunterdon Health Care System (Flemington, NJ)
- This is an in-person role. Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
- Deloitte (Philadelphia, PA)
- …clinical registered nurse, physician, physician assistant, case manager, clinical documentation specialist , utilization review , informatics RN, Quality, DRG ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk...financial concerns and other business controversy. A Clinical Documentation Specialist (CDS) works to ensure accuracy and completeness of… more
- Cardinal Health (Philadelphia, PA)
- Job Description **Senior Consultant, Product Sales Specialist - NPHS** **The territory will cover 7 pharmacies along the eastern seaboard, with cities that include ... should ideally sit in Philadelphia or Charlotte.** The Product Sales Specialist is responsible for developing opportunities, selling, growing and maintaining product… more
- Penn Medicine (Philadelphia, PA)
- …Are you living your life's work? **Job Title:** Preregistration Specialist **Department:** Ophthalmology Pathology Admin Personnel **Location:** Penn Presbyterian ... 39th Street **Hours:** Mon-Fri office hours **Summary:** + The Pre-Registration Specialist reports to the Supervisor of Financial Clearance. This individual… more
- Norstella (Trenton, NJ)
- Client Success Renewals Specialist Company: MMIT Location: Remote, United States Date Posted: Dec 22, 2025 Employment Type: Full Time Job ID: R-978 **Description** ... and responsive to patient needs. **The Role:** The Client Success Renewals Specialist works in collaboration with the Client Success Operations Manager and Client… more
- Oracle (Trenton, NJ)
- …Manager and the roles within the pods (eg, Business Analyst, Integration Specialist , QA, etc.) and contribute to strategic planning, direction, and goal setting ... procedures, contractual budgets, providing expert-level insight on the development, utilization , and revision of contractual agreements. + Maintains customer… more
- Eliassen Group (Trenton, NJ)
- …analyze requirements. + Provide expert advice on best practices for Workfront utilization . + Conduct/participate in regular meetings to review project progress ... **Workfront Configuration Specialist ** **Anywhere** **Type:** Contract **Category:** Development **Industry:** Insurance **Workplace Type:** Remote **Reference ID:**… more
- St. Luke's University Health Network (Sellersville, PA)
- …mental health/crisis intervention experience required. Previous experience with case management/ utilization review and managed care models preferred. Please ... may require treatment with seclusion/restraints. + Supports the function of utilization management regarding pre-certification process for all intakes and consults.… more
- The Cigna Group (Philadelphia, PA)
- …demographic data for assigned markets, ensuring accuracy and compliance. + Lead monthly review sessions with the contracting team to ensure the best line of sight ... schedules and projections. + Oversee the claim match and rating area review processes, driving improvements in data quality and operational efficiency. + Collaborate… more
- Evolent (Trenton, NJ)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- ChenMed (Philadelphia, PA)
- …and explain nurse practitioner role. + Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... as part of the clinical operations team and is responsible for providing specialist patient care in nursing homes, skilled nursing facilities (SNF) and home… more
- SAP (Newtown Square, PA)
- …to deliver effectively in a deadline-oriented environment. As a Marketing Execution Specialist on the Global Sponsorship team, it will be your responsibility to ... GETS (ticketing platform) as well as supporting NA CS teams to drive utilization of our partner assets. Your responsibilities will include: **Expectations & Tasks**… more
- CVS Health (Trenton, NJ)
- …the strategy to incorporate emerging trends (AI, automation) that enhance knowledge utilization . + Lead the migration to ServiceNow Knowledge Base - Oversee the ... knowledge content. Chair the Knowledge Management Governance Board to review content quality, lifecycle (updates/retirement), and incoming knowledge requests. Ensure… more
- ASM Research, An Accenture Federal Services Company (Trenton, NJ)
- …on the project in a senior administrator capacity. Considered a technical specialist in a variety of IT administrator disciplines. + Configure, monitor, and ... as needed (aside from on-call rotation). + Optimize system operations and resource utilization as well as perform system capacity analysis and planning. + Utilize… more