- Hunterdon Health Care System (Flemington, NJ)
- This is an in-person role. Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure ... an applicable health insurance plan. Primary Position Responsibilities 1. Performs utilization activities, using Milliman Care Guidelines under the guidance of the… more
- Oracle (Trenton, NJ)
- …Manager and the roles within the pods (eg, Business Analyst, Integration Specialist , QA, etc.) and contribute to strategic planning, direction, and goal setting ... procedures, contractual budgets, providing expert-level insight on the development, utilization , and revision of contractual agreements. + Maintains customer… more
- Eliassen Group (Trenton, NJ)
- …analyze requirements. + Provide expert advice on best practices for Workfront utilization . + Conduct/participate in regular meetings to review project progress ... **Workfront Configuration Specialist ** **Anywhere** **Type:** Contract **Category:** Development **Industry:** Insurance **Workplace Type:** Remote **Reference ID:**… more
- St. Luke's University Health Network (Quakertown, PA)
- …mental health/crisis intervention experience required. Previous experience with case management/ utilization review and managed care models preferred. Please ... may require treatment with seclusion/restraints. + Supports the function of utilization management regarding pre-certification process for all intakes and consults.… more
- Merck (West Point, PA)
- …supply chain deliverables and prepares, analyses, and/or develops mitigation strategies for review with clinical partners and senior leaders. + Works directly in the ... (IVR) System development and User Acceptance Testing (UAT) for assigned studies. + Utilization of key technological tools and systems for GCS planning such as SWMS,… more
- Evolent (Trenton, NJ)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- CVS Health (Trenton, NJ)
- …the strategy to incorporate emerging trends (AI, automation) that enhance knowledge utilization . + Lead the migration to ServiceNow Knowledge Base - Oversee the ... knowledge content. Chair the Knowledge Management Governance Board to review content quality, lifecycle (updates/retirement), and incoming knowledge requests. Ensure… more
- ASM Research, An Accenture Federal Services Company (Trenton, NJ)
- …on the project in a senior administrator capacity. Considered a technical specialist in a variety of IT administrator disciplines. + Configure, monitor, and ... as needed (aside from on-call rotation). + Optimize system operations and resource utilization as well as perform system capacity analysis and planning. + Utilize… more