- CVS Health (Trenton, NJ)
- …care more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...of residence + 3+ years of experience as a Registered Nurse working in ER, Med/Surg, and/or… more
- VNS Health (Manhattan, NY)
- …and updates through on-going training, coaching and educational materials. + For Utilization Management Only: + Issues Determinations, Notices of Action, and ... by state or federal regulations are saved in the Utilization Management System. + Reviews, evaluates and...and Certifications: + Current license to practice as a Registered Professional Nurse or an Occupational Therapist… more
- Centene Corporation (New York, NY)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Highmark Health (Trenton, NJ)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- VNS Health (Manhattan, NY)
- …to develop a high-quality safe discharge plan. Works with the authorization and utilization management teams to generate timely requests for medical services and ... nursing facility stay. + Coordinates with the Authorization and Utilization Management teams to ensure all required...and Certifications: + Current license to practice as a Registered Professional Nurse in New York State… more
- VNS Health (Manhattan, NY)
- …in development of plans to address improvement needs as appropriate.* For Utilization Management Only:* Issues Determinations, Notices of Action, and other ... communications required by state or federal regulations are saved in the Utilization Management System.* Reviews, evaluates and determines the appropriateness of… more
- Intermountain Health (Trenton, NJ)
- …REGISTRATION, LICENSE (*indicates primary source verification requirement) Required: + Active Registered Nurse License Preferred: + Certified Healthcare Access ... Associate (CHAA) EXPERIENCE Required: + Licensed Registered Nurse + Minimum of 2 years'...experience in acute clinical nursing setting + Knowledge of utilization management and case management … 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...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- CVS Health (Toms River, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... care more personal, convenient and affordable. **Position Summary** This is a fulltime ** remote ** opportunity with 50 to 75% travel in Ocean County and surrounding… more
- VNS Health (Manhattan, NY)
- …years' experience in a Grievance and Appeals or related area such as medical or utilization management in a Managed Care setting required + Experience in a ... Plans is seeking a dedicated Manager, Grievance and Appeals ( RN )to lead the daily operations of our grievance and...+ License and current registration to practice as a registered professional nurse in New York State… more
- Centene Corporation (New York, NY)
- …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse preferred Pay Range: $26.50 - $47.59 per ... and actions taken on member medical records in health management systems according to utilization management...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- Centene Corporation (New York, NY)
- …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse preferred Pay Range: $26.50 - $47.59 per ... utilization management processes preferred....plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- Humana (Trenton, NJ)
- …your skills to make an impact** **Required Qualifications** + Associate degree + Active Registered Nurse , ( RN ), License in your state of residence without ... project management and/or process improvement experience + Minimum 3 years utilization management experience with exposure to grievance and appeals +… more