- Humana (Trenton, NJ)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse uses behavioral health knowledge and ... licensed in a Compact State** The Utilization Management Behavioral Health Nurse completes...Qualifications** + Minimum of Associate Degree in Nursing + Registered Nurse ( RN ) licensure with… more
- AmeriHealth Caritas (Philadelphia, PA)
- …Registered Nurse ** Location: Philadelphia, PA Primary Job Function: Medical Management ID**: 34518 **Job Brief** Current PA RN . Bachelor's degree ... 3+ yrs clinical practice experience working with medically fragile pediatric patients. Utilization Management experience preferred. Your career starts now. We… more
- Elevance Health (Trenton, NJ)
- …or Mercer counties to meet face to face with patients. The **LTSS Service Coordinator- RN ** is responsible for overall management of member's case within the ... **LTSS Service Coordinator - RN ** _Location:_ This is a field based position....face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral… more
- Penn Medicine (Philadelphia, PA)
- …UPHS' mission, vision, values. Credentials: + Basic Cardiac Life Support (Required) + Registered Nurse - PA (Required) Education or Equivalent Experience: + ... our future each day. Are you living your life's work? Summary: + Assists Nurse Manager by assuming 24-hour accountability for the operation of the designated patient… more
- CVS Health (Clementon, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... personal, convenient and affordable. **Position Summary** This is a remote case management opportunity with required travel throughout Camden County NJ and the… more
- Magellan Health Services (Chalfont, PA)
- …Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt ... of the following: CEAP, LMSW, LCSW, LSW, LPC or RN . CEAP certification as required by management ....time management and communication skills. Knowledge of utilization management procedures, mental health and substance… more
- Health Advocates Network (Norristown, PA)
- …hour *W2 Minimum Qualifications Possession of a current license to practice as a Registered Nurse issued by the Pennsylvania State Board of Nursing; or ... Nursing. Resources possessing non-renewable temporary practice permits must obtain licensure as a Registered Nurse within the one-year period as defined by the… more
- CVS Health (Blue Bell, PA)
- …expense reimbursement policy. Preferred Qualifications : Oklahoma residency preferred Oklahoma-licensed registered nurse preferred OR be certified as a Certified ... a variety of external and internal audiences including senior management . Required Qualifications : * 5 to 7 years'...(CHCQM) by the American Board of Quality Assurance and Utilization Review Providers prior to employment. A minimum of… more
- Highmark Health (Trenton, NJ)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- Virtua Health (Voorhees, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... needs, monitors the length of stay and promotes efficient utilization of resources. Acts as a clinical expert and...of individual plan of care in EMR and case management documentation system. Metrics- Accountable to job specific goals,… 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 ... from the hospital, specialty care practices, health plan staff, and others, the Nurse Care Manager identifies and proactively manages the needs of patients with high… more
- The Cigna Group (Philadelphia, PA)
- **Field Based Adult/Geriatric or Family Nurse Practitioner - Evernorth - Philadelphia PA** Sign On Bonus Available **Why Should you Consider Joining Us?** 1. We ... facing chronic, complex and life-threatening illness. As an in-home primary care nurse practitioner, you will be a critical part of the interdisciplinary team… more
- Sevita (Delran, NJ)
- …strategy in partnership with the Business Development to increase census, maximize utilization and occupancy percentages, and assists with new start development as ... served, and reviews area incident reporting. + Implements area incident management protocol; ensures timely incident reporting and implementation of corrective… more