- Humana (Trenton, NJ)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Trenton, NJ)
- …more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... + Clinical experience in post-acute setting + Managed Care experience + Utilization review experience + Experience working with electronic medical record… more
- 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.... management , and budget control. Departments involved are Utilization Management , Case Management , and… 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
- Penn Medicine (Plainsboro, NJ)
- …managementPatient billing status managementDenials managementCMS Conditions of Participation Utilization review and Discharge planningData collection, auditing ... of the department with direct responsibility of the Care Coordination Nurses ( utilization review and discharge planning). Responsibilities: + Monitors daily… more
- Penn Medicine (Plainsboro, NJ)
- … of the following areas: + Quality Improvement Plan + Unit budget + Resource Utilization + Human Resource Management + Master Unit Staffing Plan + Unit Risk ... life's work? Penn Medicine Princeton Health is seeking a Nurse Manager within our Telemetry Unit. This role is... Management + Patient Satisfaction **Essential Job Duties and Responsibilities:**… 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
- Spectrum Health Services (Philadelphia, PA)
- …care team, assesses patients for risk of adverse health outcomes, inappropriate utilization , and monitors the impact of care management interventions. Essential ... specialty care practices, health plan staff, and others, the Nurse Care Manager identifies and proactively manages the needs...and home-based visits and telephonic support on a care management or case management basis appropriate to… more
- The Cigna Group (Philadelphia, PA)
- …about their care options and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all requirements 5. Explain test ... education including possible side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for the patient or… 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
- ChenMed (Philadelphia, PA)
- …of 2 years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning ... great people to join our team. The Acute Care Nurse is responsible for achieving positive patient outcomes, managing...patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with… more
- GetWellNetwork, Inc. (Philadelphia, PA)
- …Manager will take the Get Well program to the next level by driving nurse engagement, focusing on increased utilization , and leading projects of functionality to ... Well's Client Success Manager is responsible for effective product utilization and successful outcomes for the Get Well system...of the Get Well system by conducting quarterly account review meetings pertaining to account roadmap; conduct nurse… more
- Penn Medicine (Philadelphia, PA)
- …skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, team, and physician ... fearful you will miss patient contact? If so, our nurse case manager role at Penn Medicine is the...community resources, transportation, and quality data collection and risk management referral. + Responsibilities: Utilization management… more
- Evolent (Trenton, NJ)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- Virtua Health (Marlton, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... to enhance hospital system and tenant relationships. Manage the real estate management staff and overall real estate operations to support property investment plans… more
- CVS Health (Trenton, NJ)
- …+ 4+ years demonstrated experience in managed care Utilization Management to include prior authorization, concurrent review OR demonstrated experience ... the plan and works across various departments including Care Management , Utilization Management , Quality ...of the following: Licensed Clinical Social Worker (LCSW), Registered Nurse (RN), Clinical Nurse Specialist (CNS), Licensed… more
- Evolent (Trenton, NJ)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- RWJBarnabas Health (Hamilton, NJ)
- …of Microsoft applications ex. Word ,Excel Preferred: + Utilization review and discharge planning experience + Case Management certification Certifications ... for Inpatients to determine appropriateness of continued stay, care planning, utilization management and discharge planning. Required: + BSN required +… more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... community resourcesParticipates and drives accountability in daily interdisciplinary meetings Utilization Management :Adheres to guidelines to satisfy 3rd party… more
- Intermountain Health (Trenton, NJ)
- …of 2 years' experience in acute clinical nursing setting + Knowledge of utilization management and case management principles preferred KNOWLEDGE, SKILLS, ... **Job Description:** The Pre-Access Prior Authorization RN provides timely review of authorization requests and/or review of denials to ensure medical necessity,… more