- Humana (Trenton, NJ)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …utilization of resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of ... to the treatment team, Director of Utilization Management , and the Medical Director. + Review ...Degree **Licenses and Certifications Preferred:** + NJ State Professional Registered Nurse License or NJ Licensed Social… 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
- Fresenius Medical Center (Princeton, 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
- Zufall Health Center (Somerville, NJ)
- …living with HIV/AIDS. In the model for MCM Nurse , the role is provided by a registered nurse ( RN ) and will focus on the clinical services of primary care ... Registered Nurse Case Manager Somerville, NJ...with program funding policies. The level of medical case management needed by the individual clients is determined by… more
- Atlantic Health System (Morristown, NJ)
- Atlantic Visiting Nurse , part of Atlantic Health System, is seeking a full-time hospice Registered Nurse to work Monday - Friday from 8 AM to 4 PM in the ... responsible for managing a heavy caseload (up to 4 patients a day); time management skills are essential. However, it is important to provide each patient with the… 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
- Sharecare (Trenton, NJ)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Highmark Health (Trenton, NJ)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… 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
- Erickson Living (New Providence, 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
- BAYADA Home Health Care (Morristown, NJ)
- **BAYADA Home Health Care** is currently seeking a full-time ** Registered Nurse , RN ,** to fill the position of **_Clinical Nurse Manager_** in our office ... and mentoring of Clinical Associates and field staff + Utilization Management + Developing and mentoring staff... Clinical Manager include: + A current New Jersey RN license. + Strong management and leadership… 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
- Mount Sinai Health System (New York, NY)
- …to: 1. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using standardized ... Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or...Sinai St. Luke's and Mount Sinai West, BEZ - Utilization Management - WST, Mount Sinai West… more
- Mount Sinai Health System (New York, NY)
- …nursing leadership experience demonstrating solid management abilities. + Licensed as a registered nurse with current registration in New York State + Basic ... **Job Description** The Director is responsible for the management of nursing practice and operations of the Nursing Home Infusion. This includes, but is not limited… 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...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… 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
- 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 ... Responsible for direct oversight and the day to day management of clinical appeals review processes within...+ License and current registration to practice as a registered professional nurse in New York State… more