- CVS Health (Trenton, NJ)
- …And we do it all with heart, each and every day. Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends, ... Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CVS Health (Trenton, NJ)
- …able to work an Eastern Standard Time schedule** **Must be a licensed RN** + Utilization Management is a 24/7 operation and the work schedule may include ... Jersey or Compact RN License + 3+ years of clinical experience + Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and… more
- CenterWell (Trenton, NJ)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Evolent (Trenton, NJ)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- ChenMed (Philadelphia, PA)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty incumbent adheres to strict departmental goals/objectives, standards ... we need great people to join our team. The Nurse Practitioner (NP), Specialty acts as part of the...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… more
- ChenMed (Philadelphia, PA)
- …expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional patient care advice ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- Evolent (Trenton, NJ)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Intermountain Health (Trenton, NJ)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- AristaCare (Philadelphia, PA)
- Unit Manager - RN is reasonable to oversee the care management of a population of patients within an assigned area, unit or clinical function. The position conducts ... process, assessment, planning, implementation, and evaluation under the scope of the State's Nurse Practice Act of Registered Nurse licensure. The Unit Manager -… more
- Penn Medicine (Philadelphia, PA)
- …life's work? TheHospital of the University of Pennsylvania (HUP)is seeking an _Assistant Nurse Manager_ to join the _Labor & Delivery (Ravdin 7) team!_ These honors ... Obstetric Anesthesia and Perinatology Center of Excellence Award Summary: + Assists Nurse Manager by assuming 24-hour accountability for the operation of the… more
- CVS Health (Mount Laurel, NJ)
- …high-quality, cost-effective care for our members. These strategies encompass utilization management , quality improvement, network coordination, and clinical ... upon achieving proficiency in the role. **Required Qualifications** + Active, unrestricted **Registered Nurse (RN) license in New Jersey** . + Minimum of **3 years… more
- ChenMed (Philadelphia, PA)
- …clinical work experience required + A minimum of one (1) year of utilization review and/or case management , home health, hospital discharge planning experience ... through external providers and healthcare systems. The Acute Care Nurse is an important member of the Complex Care...plans. The success of this role is determined by management of patients in hospital to ensure patients receive… more
- AmeriHealth Caritas (Philadelphia, PA)
- …. **Responsibilities:** Under the supervision of the LTSS Manager/Director for Utilization Management , this position is responsible for providing daily ... Home Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and operational… more
- Magellan Health Services (Morrisville, PA)
- …Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community ... care plan, member education on health-related social needs, and care management . Entails coordination with PA HealthChoices physical health managed care… more
- Highmark Health (Trenton, NJ)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). + Delaware RN license must...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… more
- YesCare Corp (Philadelphia, PA)
- …requested. + Participate in quality care reviews and sponsor physician assistants or nurse practitioners as needed. + **Schedule Management :** Notify the Site ... Care:** Deliver evidence-based clinical services, including sick calls, chronic care management , history and physicals, and emergency care. + Visit the infirmary… more
- University of Pennsylvania (Philadelphia, PA)
- …and ultrasound. Job Description Job Responsibilities We are seeking a skilled and dedicated nurse to join our team as an Operating Room and Imaging Nurse . ... and medical terminology to support the surgical team. + Act as a circulating nurse and/or scrub nurse during surgeries, providing valuable assistance to the… 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… more
- Sharecare (Trenton, NJ)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Datavant (Trenton, NJ)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… more