- Lincoln Financial Group (Trenton, NJ)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- CVS Health (Trenton, NJ)
- …convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Clinical Consultant opportunity. Schedule is Monday-Friday with ... Electronic Medical Record documentation experience **Preferred** **Qualifications** + Managed care/ utilization review experience + Experience in a behavioral… more
- Humana (Trenton, NJ)
- …and ad hoc reports in Access and/or SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse (RN) Credentials + Home Health, ... Durable Medical Equipment, and/or Skilled Nursing Facility Experience **Additional Information** **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week)… more
- Carbon Lehigh Intermediate Unit 21 (Schnecksville, PA)
- Classroom Nurse JobID: 1260 + Position Type: PROFESSIONAL/ Classroom Nurse + Date Posted: 10/31/2022 + Location: Schnecksville, PA Position ... and Services under the clinical guidance from the Certified School Nurse . Qualifications: Education/Experience: + Bachelor's Degree in nursing (BSN). + Valid… more
- Penn Medicine (Philadelphia, PA)
- …Are you living your life's work? Penn Medicine is seeking a full-time Clinical Nurse Educator for Periop Unit with Penn Presbyterian Medical Center. Summary: + The ... Clinical Nurse Educator (CNE) practices within the UPHS professional practice...includes the traditional components of patient care, consultation, research utilization and education with the aims of upholding practice… more
- NJM Insurance (Trenton, NJ)
- …Workers' Compensation line of business by performing prospective and retrospective Utilization Review of pharmaceutical/medication requests in accordance with ... comply with all statutory, regulatory, licensing requirements, and NJM policies/guidelines that affect nurse case management and medical management work. +… more
- Penn Medicine (Philadelphia, PA)
- …a redesigned front end to expedite patient flow. **Summary:** + The Clinical Nurse Educator (CNE) practices within the UPHS professional practice model and exhibits ... that includes the traditional components of patient care, consultation, research utilization and education with the aims of upholding practice standards,… more
- The Cigna Group (Philadelphia, PA)
- …at home to improve quality of life, increase understanding and management of serious illness, facilitate coordination between providers, and decrease unnecessary ... includes health risk assessments, transitions of care, complex and chronic disease management , and palliative care support. We conduct in-home longitudinal care for… 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
- Genesis Healthcare (Philadelphia, PA)
- …written, verbal and listening communication abilities.9. Prior experience in utilization review or discharge planning preferred.10. Certifications: CCM, ... job grade, location, and length of service. The Care Transitions Nurse develops strong relationships with Hospital/Health System providers, Hospitalists, Physicians,… more
- Genesis Healthcare (Philadelphia, PA)
- …Position Highlights*Participate in the development, implementation, evaluation and outcomes management of reimbursement priorities in nursing centers to assure ... proper utilization of services to maximize revenues.*Advise and assist the...training classes. *Participate in nursing centers' Medicare meetings to review coverage and documentation issues and requirements. Report any… more
- Fresenius Medical Center (Limerick, 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
- Fresenius Medical Center (Swarthmore, PA)
- …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
- Prime Therapeutics (Trenton, NJ)
- …+ Escalates medical exception requests to nurse , pharmacist or physician on the utilization review clinical team when further review is necessary. + ... company achieving revenue goals and operational objectives. Responsible for executing utilization management programs on behalf of health plan/payor customers,… more
- NJM Insurance (Trenton, NJ)
- …of experience preferred in: Med-Surg and critical care and clinical nursing, Utilization Management Review /Hospital concurrent reviews, and/or Hospital Bill ... will perform all aspects of utilization management : case management intervention, precertification, concurrent review , and retrospective review . This… more
- Penn Medicine (Philadelphia, PA)
- …thinking skills and being a strong patient advocate.The case manager conducts utilization management activities, communication with insurers, team, and physician ... are 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
- Elevance Health (Wilmington, DE)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment… 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 ... resources + Participates and drives accountability in daily interdisciplinary meetings + Utilization Management : + Adheres to guidelines to satisfy 3rd party… more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... resources Participates and drives accountability in daily interdisciplinary meetings + Utilization Management : Adheres to guidelines to satisfy 3rd party… more