- Insight Global (Philadelphia, PA)
- …Active RN License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review) Strong computer skills Ability to ... looking for HEDIS RNs or LPNs for a partially remote contract position in PA and NJ. PARTIALLY ...of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer… more
- Highmark Health (Trenton, NJ)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… 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...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- CVS Health (Stratford, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... more personal, convenient and affordable. **Position Summary** This is a fulltime ** remote ** opportunity with 50 to 75% travel in Camden and surrounding counties.… more
- CVS Health (Trenton, NJ)
- …visit, inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN , the TOC Coach ensures the member experiences a ... impact on our members, who are enrolled in Care Management and present with a wide range of complex...or changes in condition to be transitioned back to RN . + Complete post discharge call and required assessments… more
- Humana (Trenton, NJ)
- …your skills to make an impact** **Required Qualifications** + Associate degree + Active Registered Nurse , ( RN ), License in your state of residence without ... project management and/or process improvement experience + Minimum 3 years utilization management experience with exposure to grievance and appeals +… more
- AmeriHealth Caritas (Newtown Square, PA)
- …complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable. + Monitor appropriate utilization and ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more