- CVS Health (Trenton, NJ)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- US Tech Solutions (Hopewell, NJ)
- …case/care management principles. - Prefers working knowledge of principles of utilization management . - Prefers basic knowledge of health care contracts and ... to the continuum of care. Performs duties and types of care management as assigned by management .** **Responsibilities:** 1. Assesses patient's clinical… more
- CenterWell (Trenton, NJ)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- CVS Health (Trenton, NJ)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- ChenMed (Philadelphia, PA)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty incumbent adheres to strict departmental goals/objectives, standards ... we need great people to join our team. The Nurse Practitioner (NP), Specialty acts as part of the...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… more
- Penn Medicine (Philadelphia, PA)
- …each day. Are you living your life's work? Summary: + The Clinical Nurse Educator (CNE) practices within the UPHS professional practice model and exhibits UPHS ... that includes the traditional components of patient care, consultation, research utilization and education with the aims of upholding practice standards,… more
- ChenMed (Philadelphia, PA)
- …expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional patient care advice ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- Evolent (Trenton, NJ)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- BAYADA Home Health Care (Blue Bell, PA)
- …in Senior Living **_._** Are you a solutions-oriented, team-focused **Registered Nurse , Licensed Practical Nurse or Therapist (Physical Therapist, Occupational ... create alignment to common goals across multiple levels of management ? Would you like to be viewed as a...members to deliver on our differentiated offerings. Through the utilization of outcome driven data analytics, this role will… more
- AristaCare (Philadelphia, PA)
- Unit Manager - RN is reasonable to oversee the care management of a population of patients within an assigned area, unit or clinical function. The position conducts ... process, assessment, planning, implementation, and evaluation under the scope of the State's Nurse Practice Act of Registered Nurse licensure. The Unit Manager -… more
- Penn Medicine (Philadelphia, PA)
- …life's work? TheHospital of the University of Pennsylvania (HUP)is seeking an _Assistant Nurse Manager_ to join the _Labor & Delivery (Ravdin 7) team!_ These honors ... Obstetric Anesthesia and Perinatology Center of Excellence Award Summary: + Assists Nurse Manager by assuming 24-hour accountability for the operation of the… more
- CVS Health (Burlington, NJ)
- …high-quality, cost-effective care for our members. These strategies encompass utilization management , quality improvement, network coordination, and clinical ... upon achieving proficiency in the role. **Required Qualifications** + Active, unrestricted **Registered Nurse (RN) license in New Jersey** . + Minimum of **3 years… more
- Fresenius Medical Center (Flemington, NJ)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- ChenMed (Philadelphia, PA)
- …clinical work experience required + A minimum of one (1) year of utilization review and/or case management , home health, hospital discharge planning experience ... through external providers and healthcare systems. The Acute Care Nurse is an important member of the Complex Care...plans. The success of this role is determined by management of patients in hospital to ensure patients receive… more
- University of Pennsylvania (Philadelphia, PA)
- …and ultrasound. Job Description Job Responsibilities We are seeking a skilled and dedicated nurse to join our team as an Operating Room and Imaging Nurse . ... and medical terminology to support the surgical team. + Act as a circulating nurse and/or scrub nurse during surgeries, providing valuable assistance to the… more
- YesCare Corp (Philadelphia, PA)
- …requested. + Participate in quality care reviews and sponsor physician assistants or nurse practitioners as needed. + **Schedule Management :** Notify the Site ... Care:** Deliver evidence-based clinical services, including sick calls, chronic care management , history and physicals, and emergency care. + Visit the infirmary… more
- St. Luke's University Health Network (Sellersville, PA)
- …, including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among all ... across the continuum of care. Also works with the providers, registered nurse care managers, and multi-disciplinary care teams to facilitate the achievement of… more
- Intermountain Health (Trenton, NJ)
- …+ Care Management Certification + Demonstrated experience in case management , utilization review, or discharge planning. + Bi-Lingual/Spanish Speaking ... The RN Ambulatory Care Manager I delivers comprehensive ambulatory care management services to identified patients. Leveraging clinical expertise, this role involves… more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... community resources + Participates and drives accountability in daily interdisciplinary meetings Utilization Management : + Adheres to guidelines to satisfy 3rd… more
- Sharecare (Trenton, NJ)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more