- 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
- 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....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …utilization of resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of ... to the treatment team, Director of Utilization Management , and the Medical Director. + Review ...Degree **Licenses and Certifications Preferred:** + NJ State Professional Registered Nurse License or NJ Licensed Social… 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 (Princeton, 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
- Zufall Health Center (Somerville, NJ)
- …living with HIV/AIDS. In the model for MCM Nurse , the role is provided by a registered nurse ( RN ) and will focus on the clinical services of primary care ... Registered Nurse Case Manager Somerville, NJ...with program funding policies. The level of medical case management needed by the individual clients is determined by… 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
- Hackensack Meridian Health (Holmdel, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to.... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… 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
- RWJBarnabas Health (New Brunswick, NJ)
- …Catheter Lab. The Director of the Cardiac Cath Lab and Physiology departments is a Registered Nurse ( RN ) with the knowledge, skill and competence in the ... Director, Cardiac Catheter Lab ( RN ) - New Brunswick, NJReq #:0000151612 Category:Nursing Manager...and appropriate coverage for operations + Directs all quality review functions and operations in the Department. This includes… more
- Penn Medicine (Plainsboro, NJ)
- …graduate level education. . **_Related Work Experience_** + Previous experience working as a Registered Nurse . + Unit Budget We believe that the best care ... room, and Congestive Heart Failure Coordinator. This is a registered professional nurse responsible for visioning, overseeing,...+ Quality Improvement Plan + Unit budget + Resource Utilization + Human Resource Management + Master… 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
- US Tech Solutions (Branchburg, NJ)
- … on an **acute/critical care** unit, organ donation/transplant unit, in tissue/blood banking, utilization review and/or case management with critical care ... Schedule - 7:30 am-4:00 pm M-F We need an RN that has at least 5 years' experience in...Tissue/Blood banking * Critical care skill set. The chart review is critical, and the candidate must have knowledge… more
- Evolent (Trenton, NJ)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- RWJBarnabas Health (Somerset, NJ)
- …Required: + Graduate of an approved school of nursing + New Jersey Professional Registered Nurse License + Valid Driver's License from a USA state + ... and Licenses Required: + Requires a New Jersey Professional Registered Nurse License + Valid Driver's License...and assesses the use of hospital services by administering utilization review procedures under Federal, State and… 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. +...Master's degree. **Licenses and Certifications Required:** + NJ Licensed Registered Nurse or NJ Licensed Social Worker… more