- Eisai, Inc (Nutley, NJ)
- …states: AL, FL, GA, MS, Puerto RicoJob Summary The Eisai Federal Account Specialist - Oncology and Neurology (FAS) will be responsible for meeting sales goals ... and proactively driving local solutions. Essential Functions Educate on utilization of promoted therapeutic products for specific indications; deliver clinical,… more
- Hackensack Meridian Health (Hackensack, NJ)
- **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- 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
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is ... responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD)… more
- Deloitte (Morristown, NJ)
- …clinical registered nurse, physician, physician assistant, case manager, clinical documentation specialist , utilization review , informatics RN, Quality, DRG ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk...financial concerns and other business controversy. A Clinical Documentation Specialist (CDS) works to ensure accuracy and completeness of… more
- Oracle (Trenton, NJ)
- …stays. + Knowledge of third-party payor rules and regulations. + 2-3 years of Utilization Review experience in a healthcare setting preferred; 1-2 years of ... college and AHIMA Certified RHIT credentials preferred + Certification in Utilization Review , case management, and healthcare quality preferred… 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
- Hackensack Meridian Health (Red Bank, NJ)
- …ED inpatient admissions and observations as specified by the facility's Utilization Management/ Review Committee for documentation completeness and compliance ... and serve as a leader of positive change. The **Clinical Documentation Specialist RN** facilitates improvement in the overall quality, completeness and accuracy of… more
- Datavant (Trenton, NJ)
- …The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity ... author appeal letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers + Provide proper… 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 ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- SHI (Somerset, NJ)
- …NJ office location. **Role Description** + Change Request Coordination: Receive and review change requests, ensuring that the requisite information is provided and ... and facilitate communication during the implementation process. + Post-Implementation Review : Participate in post-implementation reviews to assess the success and… more
- Citigroup (Paramus, NJ)
- …the appropriate partners as necessary (eg leverage video conference for FA, mortgage specialist , etc.) + Take full ownership of clients' problems to resolve client ... digital first approach, focus on client problem resolution and effective utilization digital technologies + Resolving complex client issues or needs; connect… 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
