- 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 (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
- 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
- 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
- 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
- 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
- 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
- Hackensack Meridian Health (Brick, NJ)
- …computer skills. 5. Familiar with hospital resources, community resources, and utilization management . 6. Excellent written and verbal communication skills. ... or meetings. 8. Identifies and refers quality issues for review to the Quality Management Program. 9....Master's degree. Licenses and Certifications Required: 1. NJ Licensed Registered Nurse or NJ Licensed Social Worker… 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
- 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 (Brick, 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
- 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
- Sharecare (Trenton, NJ)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... members of the health care team to support appropriate total healthcare management . RD colleague is supervised by an Operations Manager. All Sharecare clinicians… more
- Cardinal Health (Trenton, NJ)
- …and service education to facilitate technology adoption and workflow change management . + Demonstrates extensive knowledge and understanding of relevant clinical ... best demonstrated practices + Significantly influences customer acceptance and utilization of new products and services in multi-site and/or...of the time + Bachelor's degree preferred + Current RN license preferred + 6-8 years of experience in… more