- CVS Health (Trenton, NJ)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Evolent (Trenton, NJ)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals.… more
- Philips (Mercerville, NJ)
- …imaging equipment etc) with clinical experience as Radiologic Technologist (RT) or Registered Nurse (RN) highly preferred. + Experience in healthcare (in the ... **Sales Support, Clinical Specialist - FORS (West/National Travel)** In this...to effectively manage assigned accounts in terms of driving utilization , customer relationship management, problem resolution, etc. + You… more
- Penn Medicine (Plainsboro, NJ)
- …proactively identify potential denials in order to avoid non-appealable denials; Credentials: + Registered Nurse - NJ (Required) + Certified Case Manager + ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- AristaCare (Manchester, NJ)
- …process, assessment, planning, implementation, and evaluation under the scope of the State's Nurse Practice Act of Registered Nurse licensure. The Unit ... Manager - RN coordinates resource utilization , timely and appropriate care interventions, and interdisciplinary communication...and regulatory compliance. Requirements; + Must possess, a valid Registered Nurse license in the state of… more
- Highmark Health (Trenton, NJ)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- RWJBarnabas Health (Trenton, NJ)
- …Director Cancer Center has administrative oversight for Cancer Center and is a Registered Nurse (RN) with the knowledge, skill and competence in the ... quality review functions and operations in the Department. This includes the clinical management of patients, patient satisfaction and safety and effective and… more