- Cordis (Trenton, NJ)
- …together. **We are the people behind the people who keep saving lives.** The ** Clinical Closure Sales Specialist** is focused on the support of the Cordis closure ... (transactional Business) through direct case support. ?Reports to National Clinical Sales Director.? **Responsibilities** + Responsible for meeting revenue… more
- CVS Health (Trenton, NJ)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... holidays, and evening hours. * Utilizes clinical experience and skills in a collaborative process to...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… 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 ... duties and types of care management as assigned by management .** **Responsibilities:** 1. Assesses patient's clinical need against established guidelines… more
- CVS Health (Trenton, NJ)
- …and unrestricted RN licensure in New Jersey or Compact RN License + 3+ years of clinical experience + Utilization Management is a 24/7 operation and work ... Eastern Standard Time schedule** **Must be a licensed Registered Nurse , any compact licensure must cover New Jersey** +..., any compact licensure must cover New Jersey** + Utilization Management is a 24/7 operation and… more
- CenterWell (Trenton, NJ)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Evolent (Trenton, NJ)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Fresenius Medical Center (Flemington, NJ)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- CVS Health (Trenton, NJ)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Penn Medicine (Plainsboro, NJ)
- …treatment plan reviews within established timeframes + Communicate effectively the essential clinical features of each case with utilization reviewers and ... discharge planning and communicates plan clearly to patient, family and Utilization Review Nurse , Financial Counselor and outpatient treatment providers… more
- Sharecare (Trenton, NJ)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- Oracle (Trenton, NJ)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… more
- Highmark Health (Trenton, NJ)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Knowledge, Skills and Abilities Preferred: + Knowledge of evidence-based criteria, utilization review, discharge planning and case management . Licenses and ... Supervisor** demonstrates HMH values, leadership and interpersonal skills to oversee the clinical and leadership functions of the Medical Center in the absence of… more
- Virtua Health (Evesham, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... processes and maintains required documentation and reports such as productivity/ utilization , medical records, customer surveys, audits, financial reports, staff… more
