• Change Execution Consultant

    Highmark Health (Trenton, NJ)
    **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job plays a key role in ensuring projects (ie change initiatives) meet objectives on time ... to implementation. Works to drive faster adoption, higher ultimate utilization and greater proficiency of the changes that impact...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
    Highmark Health (09/19/25)
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  • Pharmacist - Case and Disease Management (CMDM)…

    Highmark Health (Trenton, NJ)
    …program + 5 - 7 years in Pharmacy + 3 - 5 years in Pharmacist - Utilization Management + 3 - 5 years in Pharmacist - Medical Therapy Management **Preferred** + None ... job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… more
    Highmark Health (11/15/25)
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  • Special Needs Plan- Support Social Services

    Humana (Trenton, NJ)
    …community and help us put health first** The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' ... appropriate for the care and wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work assignments are varied and frequently require… more
    Humana (11/06/25)
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  • Senior Value-Based Programs Professional

    Humana (Trenton, NJ)
    …+ Administers new innovative VBP models for range of provider types, such as behavioral health , maternity, specialists, and social determinants of health , ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...move providers from volume to value. + Analyzes financial, utilization , and performance data to identify opportunities to drive… more
    Humana (11/11/25)
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  • PCO Medical Director- UM - Full Time

    CenterWell (Trenton, NJ)
    …best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can ... part of our caring community and help us put health first** The Medical Director, Primary Care relies on...Will report to the Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization … more
    CenterWell (11/06/25)
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  • Clinical Program Advisor/Program Management…

    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, ... close attention to detail and accuracy + Review custom Utilization Management policies for rebate eligibility or adherence to...of benefits, with a focus on supporting your whole health . Starting on day one of your employment, you'll… more
    The Cigna Group (11/15/25)
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  • Program Director

    Legacy Treatment Services (Northfield, NJ)
    …program and team, including consultation on clinical activities, therapeutic and behavioral assistance supports and direct on-site intervention with youth and ... the collection of required data and documentation on youth access and utilization of services. Supervise the medical team, Assistant Program Director, and… more
    Legacy Treatment Services (10/23/25)
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  • Disease Management Nurse - Remote

    Sharecare (Trenton, NJ)
    **Job Description:** Sharecare is the leading digital health company that helps people - no matter where they are in their health journey - unify and manage all ... their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans,… more
    Sharecare (10/22/25)
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  • Outpatient Clinician

    Prime Healthcare (Boonton Township, NJ)
    …network of hospitals and healthcare facilities include Denville Hospital, Dover Hospital, Behavioral Health Centers in Boonton, Denville, and Parsippany, and an ... Overview At Saint Clare's Health , our dedicated team of professionals is committed...required to ensure continuity of care. Completes all required utilization review tasks as assigned. For Outpatient and Residential… more
    Prime Healthcare (11/05/25)
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  • Managed Care Resident - Express Scripts (Formulary…

    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, ... into the PBM environment and the inner workings of an integrated health services company, preparing participants for impactful post-residency roles within the… more
    The Cigna Group (09/27/25)
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