- 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 (Toms River, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... care more personal, convenient and affordable. **Position Summary** This is a fulltime ** remote ** opportunity with 50 to 75% travel in Ocean County and surrounding… 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