- Atlantic Health System (Summit, NJ)
- …an Advanced Comprehensive Stroke Center. Additional Joint Commission-certified services include behavioral health care, spine surgery, wound care, and primary ... Atlantic Health is Seeking a Physician Advisor in Summit,...practice guideline development and application, risk management principles + Utilization -specific training from ABQAURP (The American Board of Quality… more
- CVS Health (Trenton, NJ)
- …Michigan, Virginia, Pennsylvania, and New Jersey** offering a variety of physical and behavioral health programs and services to its membership. Aetna is looking ... Multiple state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan… more
- The Cigna Group (Morris Plains, NJ)
- …several health -related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, ... by the client + Develop, prepare, and present clinical business strategies (formulary, utilization and/or health management strategy, support for client P&T and… more
- Highmark Health (Trenton, NJ)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... nature for profiling providers, assessing patient outcomes, studying cost and utilization trends and quantitative projections of industry and competitor performance,… more
- SERV Behavioral Health System (Hamilton, NJ)
- …regional program sites as needed. REQUIRED LICENSES/EXPERIENCE: + Master's degree in behavioral health discipline from an accredited school. + Clinical license ... BCBA, LCSW, LSW, etc.) preferred. + Minimum of seven years' experience in behavioral health , developmental disabilities, or human services with at least five… more
- CVS Health (Trenton, NJ)
- …experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health /Substance Abuse or Maternity/ Obstetrics experience. ... At CVS Health , we're building a world of health...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- Atlantic Health System (Summit, NJ)
- …an Advanced Comprehensive Stroke Center. Additional Joint Commission-certified services include behavioral health care, spine surgery, wound care, and primary ... of selected member populations across the continuum of illness. Ensures effective utilization and monitors health care resources. Manages the interdisciplinary… more
- Elevance Health (Woodbridge, NJ)
- …the identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. + Obtains a thorough and accurate member history… more
- Highmark Health (Trenton, NJ)
- …**JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most ... URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team… more
- Highmark Health (Trenton, NJ)
- …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 ... successful and measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and analyzes qualitative and… more