- Humana (Trenton, NJ)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- NJM Insurance (Trenton, NJ)
- …years of prior experience in clinical nursing (Med-Surg or Critical Care preferred), Utilization Management Review /Hospital concurrent reviews, and/or Case ... comply with all statutory, regulatory, licensing requirements, and NJM policies/guidelines that affect utilization review and medical management work. + Stay… more
- Fresenius Medical Center (Toms River, 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
- Highmark Health (Trenton, NJ)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sharecare (Trenton, NJ)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Highmark Health (Trenton, NJ)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- CVS Health (Trenton, NJ)
- …personal, convenient and affordable. **Position Summary** This is a full-time remote Utilization Management Nurse Consultant opportunity. Utilization ... include weekends and holidays and evening rotations. As a Utilization Management Nurse Consultant, you...of residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical… more
- RWJBarnabas Health (Hamilton, NJ)
- …of Microsoft applications ex. Word ,Excel Preferred: + Utilization review and discharge planning experience + Case Management certification Certifications ... Inpatients to determine appropriateness of continued stay, care planning, utilization management and discharge planning. Required: +...and Licenses Required: + Current license as a registered Nurse in the State of NJ… more
- Guardian Life (Trenton, NJ)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- CVS Health (Trenton, NJ)
- …state of New Jersey as one of the following: Licensed Clinical Social Worker (LCSW), Registered Nurse ( RN ), Clinical Nurse Specialist (CNS), Licensed ... + 4+ years demonstrated experience in managed care Utilization Management to include prior authorization, concurrent review OR demonstrated experience… more