- Humana (Trenton, NJ)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...to make an impact** **Required Qualifications** + Active licensed Registered Nurse ( RN ) in the… more
- Humana (Trenton, NJ)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Insight Global (Philadelphia, PA)
- …Active RN License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review) Strong computer skills Ability to ... looking for HEDIS RNs or LPNs for a partially remote contract position in PA and NJ. PARTIALLY ...of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer… more
- ChenMed (Philadelphia, PA)
- …RN with bachelor's degree in a related clinical field preferred. + A valid, active Registered Nurse ( RN ) license in State of employment required. + A ... great people to join our team. The Acute Care Nurse is responsible for achieving positive patient outcomes, managing...experience required. + A minimum of 1 year of utilization review and/or case management , home health,… more
- Magellan Health Services (Newtown, PA)
- …- Licensed Professional Counselor - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... with necessary degrees: CEAP, LMSW, LCSW, LSW, LPC or RN . Minimum 2 years experience post degree in healthcare,...time management and communication skills. Knowledge of utilization management procedures, mental health and substance… more
- CVS Health (Bordentown, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... possess valid/current NJ Choice Certification** **Position Summary** This is a fulltime ** remote ** opportunity with 50 to 75% travel in Mercer/Burlington County and… more
- CVS Health (Trenton, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... lives. The most rewarding aspect of the MLTSS care management role is evidenced by the positive outcomes of...one of the following active unrestricted NJ State Licensure RN , LSW, or LCSW + .Successful completion of the… more
- Sharecare (Trenton, NJ)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... the health care team to support appropriate total healthcare management . RD colleague is supervised by an Operations Manager....will follow company policy to transfer call to an RN or appropriate colleague when member needs are outside… more
- Lincoln Financial Group (Trenton, NJ)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at home employee residing outside...Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's… more
- Highmark Health (Trenton, NJ)
- …organizational systems **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + Registered Dietician + Registered Nurse **EDUCATION** **Required** ... clinical initiatives/programs to the customer audiences through effective project management , collaboration and application of best practices and engagement.… more