- Humana (Trenton, NJ)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Trenton, NJ)
- …more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... + Clinical experience in post-acute setting + Managed Care experience + Utilization review experience + Experience working with electronic medical record… more
- Baylor Scott & White Health (Trenton, NJ)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff.... management , and budget control. Departments involved are Utilization Management , Case Management , and… 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
- Penn Medicine (Plainsboro, NJ)
- …managementPatient billing status managementDenials managementCMS Conditions of Participation Utilization review and Discharge planningData collection, auditing ... of the department with direct responsibility of the Care Coordination Nurses ( utilization review and discharge planning). Responsibilities: + Monitors daily… more
- Zufall Health Center (Somerville, NJ)
- Registered Nurse Case Manager Somerville, NJ 08876, USA Req #10615 Wednesday, April 17, 2024 Welcome to Zufall Health! Position Summary The goal of the Medical Case ... Manager (MCM) Nurse is to provide a wide range of client-centered...with program funding policies. The level of medical case management needed by the individual clients is determined by… more
- Penn Medicine (Plainsboro, NJ)
- … of the following areas: + Quality Improvement Plan + Unit budget + Resource Utilization + Human Resource Management + Master Unit Staffing Plan + Unit Risk ... life's work? Penn Medicine Princeton Health is seeking a Nurse Manager within our Telemetry Unit. This role is... Management + Patient Satisfaction **Essential Job Duties and Responsibilities:**… more
- US Tech Solutions (Branchburg, NJ)
- …RN on an **acute/critical care** unit, organ donation/transplant unit, in tissue/blood banking, utilization review and/or case management with critical care ... Tissue/Blood banking * Critical care skill set. The chart review is critical, and the candidate must have knowledge...international and state regulations during the second level quality review of all **tissue donor files** for tissue submitted… more
- Fresenius Medical Center (Somerville, NJ)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Evolent (Trenton, NJ)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- Hackensack Meridian Health (Edison, NJ)
- …expert computer skills. + Familiar with hospital resources, community resources, and utilization management . + Excellent written and verbal communication skills. ... or meetings. + Identifies and refers quality issues for review to the Quality Management Program. +...degree. **Licenses and Certifications Required:** + NJ Licensed Registered Nurse or NJ Licensed Social Worker or NJ Licensed… more
- CVS Health (Trenton, NJ)
- …+ 4+ years demonstrated experience in managed care Utilization Management to include prior authorization, concurrent review OR demonstrated experience ... the plan and works across various departments including Care Management , Utilization Management , Quality ...of the following: Licensed Clinical Social Worker (LCSW), Registered Nurse (RN), Clinical Nurse Specialist (CNS), Licensed… more
- Evolent (Trenton, NJ)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- RWJBarnabas Health (Hamilton, NJ)
- …of Microsoft applications ex. Word ,Excel Preferred: + Utilization review and discharge planning experience + Case Management certification Certifications ... for Inpatients to determine appropriateness of continued stay, care planning, utilization management and discharge planning. Required: + BSN required +… more
- Intermountain Health (Trenton, NJ)
- …of 2 years' experience in acute clinical nursing setting + Knowledge of utilization management and case management principles preferred KNOWLEDGE, SKILLS, ... **Job Description:** The Pre-Access Prior Authorization RN provides timely review of authorization requests and/or review of denials to ensure medical necessity,… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Preferred: + Knowledge of milliman and/or interqual criteria, utilization review , discharge planning and case management Licenses and Certifications ... patient flow and assure continuity of care. Report pertinent information to management and administration. They provide supervision of staff in the delivery of… more
- Hackensack Meridian Health (Edison, NJ)
- …Preferred: 1. Knowledge of milliman and/or interqual criteria, utilization review , discharge planning and case management . Licenses and Certifications ... patient flow and assure continuity of care. Report pertinent information to management and administration. He/she provides supervision of staff in the delivery of… more
- RWJBarnabas Health (Somerset, NJ)
- …needs. + Monitors and assesses the use of hospital services by administering utilization review procedures under Federal, State and hospital guidelines. + ... approved school of nursing + New Jersey Professional Registered Nurse License + Valid Driver's License from a USA...+ 5 years of experience in Health Care Nursing Management , ED or ICU patient care setting + Two… more
- RWJBarnabas Health (New Brunswick, NJ)
- …The Director of the Cardiac Cath Lab and Physiology departments is a Registered Nurse (RN) with the knowledge, skill and competence in the field of invasive cardiac ... + Staff adequate and appropriate coverage for operations + Directs all quality review functions and operations in the Department. This includes the clinical … more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Preferred: + Knowledge of milliman and/or interqual criteria, utilization review , discharge planning and case management Licenses and Certifications ... patient flow and assure continuity of care. Report pertinent information to management and administration. They provide supervision of staff in the delivery of… more