- 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) with no… 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
- 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
- Molina Healthcare (New York, NY)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
- Molina Healthcare (Manhattan, NY)
- …disabled people who are eligible for Medicaid and Medicare. We are looking for Registered Nurse Care Review Clinicians with Prior Authorization experience. ... Experience with Utilization Management (UM) is highly preferred. **KNOWLEDGE/SKILLS/ABILITIES** + Assesses services...Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational… 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
- Northwell Health (Staten Island, NY)
- **Req Number** 144355 Registered Nurse Case Manager - FlexStaff Serves as liaison between the patient and facility/physician. Ensures a continuum of quality ... + Facilitates patient management throughout hospitalization + Performs concurrent utilization management using evidence based medical necessity criteria +… 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
- FlexStaff (New York, NY)
- …experience in care/case management , disease management , population health management , utilization review , quality assurance, or discharge planning ... intake clinical assessment, reassessment, UAS-NY completion, comprehensive assessment, medication review , and post-hospital discharge evaluation. An ideal candidate would… 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 ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- CVS Health (Trenton, NJ)
- …more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... of residence + 3+ years of experience as a Registered Nurse working in ER, Med/Surg, and/or...experience in post-acute setting + Managed Care experience + Utilization review experience + Experience working with… 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
- 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
- Molina Healthcare (New York, NY)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… 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
- 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
- Mount Sinai Health System (New York, NY)
- …to: a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using standardized ... **Job Description** ** RN /Case Manager MSH Case Management FT...Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or… 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