- CVS Health (Trenton, NJ)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in EST zones **Education**… more
- US Tech Solutions (Hopewell, NJ)
- …case/care management principles. - Prefers working knowledge of principles of utilization management . - Prefers basic knowledge of health care contracts and ... to the continuum of care. Performs duties and types of care management as assigned by management .** **Responsibilities:** 1. Assesses patient's clinical… 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
- Hackensack Meridian Health (Edison, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Hackensack Meridian Health (Hackensack, NJ)
- …and families. 12. Evaluates patient/family transition of care planning for resource utilization , cost, quality, and promotion of self- management for chronic ... **The post-graduate internal medicine fellowship for Nurse Practitioners is designed to provide Advanced Practice...8. Displays support of the institutional pillars through systems management , change management , and scholarly practices. 9.… more
- Atlantic Health System (Morristown, NJ)
- Atlantic Visiting Nurse , part of Atlantic Health System, is seeking a part-time hospice Registered Nurse to work 9 AM to 7 PM in the Morris County area, ... managing a heavy caseload (4 patients a day); time management skills are essential. However, it is important to...of care for the patient and family Ensures appropriate utilization of services + Maintains visit productivity standards +… 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
- St. Luke's University Health Network (Phillipsburg, NJ)
- …, including but not limited to: Social workers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among ... The RN Care Manager coordinates the overall progression of care, resource utilization , and discharge planning for designated patient populations 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
- Elevance Health (Woodbridge, NJ)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- RWJBarnabas Health (Newark, NJ)
- … Nurse (RN) Full Time Days CTICUReq #:0000204650 Category:Nursing Management / Leadership Status:Full-Time Shift:Day Facility:Newark Beth Israel Medical Center ... standards. Support of the Healthcare Environment Ensures effective, appropriate utilization of human, fiscal, and material resources by assuring appropriate… more
- Chatham Hills Subacute Care Center (Chatham, NJ)
- Schedule . 5 days a week 37.5 - 40 hours per week Respiratory Nurse (RN) We are searching for a highly motivated, flexible, organized, skilled respiratory therapist ... meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training sessions. +… more
- Fresenius Medical Center (Teaneck, NJ)
- …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
- US Tech Solutions (Branchburg, NJ)
- …on an acute/critical care unit, organ donation/transplant unit, in tissue/blood banking, utilization review and/or case management with critical care skillset ... Critical Care + Organ donation transplant unit experience. + Review or case management experience. **Nice to have (but not required) skill** + Associate degree or,… more
- Fresenius Medical Center (Union, NJ)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- US Tech Solutions (Branchburg, NJ)
- …on an **acute/critical care** unit, organ donation/transplant unit, in tissue/blood banking, utilization review and/or case management with critical care skill ... set knowledge preferred * CTBS Certified or willing to obtain within two years of employment **Essential Skills, Experience, and Competencies** Understanding & Recognizing (but not limited) the following: * physical assessment findings * history & physical… more
- Hackensack Meridian Health (Manahawkin, NJ)
- …expert computer skills. + Familiar with hospital resources, community resources, and utilization management . + Excellent written and verbal communication skills. ... a leader of positive change. The **Care Coordinator, Care Management ** is a member of the healthcare team and...degree. **Licenses and Certifications Required:** + NJ Licensed Registered Nurse or NJ Licensed Social Worker or NJ Licensed… more
- Elevance Health (Morristown, NJ)
- **Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management ** **Virtual** : This role enables associates to work virtually ... proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in… 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
- Atlantic Health System (Morristown, NJ)
- …results. * Demonstrated strength in resource management and financial management . * Experience with ANCC Magnet nurse standards. Performance Expectations ... results. * Demonstrated strength in resource management and financial management . * Experience with ANCC Magnet nurse standards. Performance Expectations… more