- CVS Health (Haddonfield, NJ)
- …to or within Passaic County, New Jersey + Candidate must have an active and unrestricted Registered Nurse ( RN ) license in New Jersey + Candidate must be ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...Degree in Nursing (PREFERRED) **License** + Active and unrestricted Registered Nurse ( RN ) license in… more
- 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 ... virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...setting. + A Registered Nurse that holds an active, unrestricted… more
- CVS Health (Wall, NJ)
- …and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. Help ... a whole new level! **Key Responsibilities** + Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. + Applies… more
- Sedgwick (Trenton, NJ)
- …providers to support the claim request and documents decision rationale. + Completes medical review of all claims by reviewing medical documentation ... clinical evaluations on claims that require additional review based on medical condition, client requirement,... management of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL… more
- Elevance Health (Woodbridge, NJ)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Highmark Health (Trenton, NJ)
- …+ 1-3 years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related ... rejection and the proper action to complete the retrospective claim review with the goal of proper...Review process includes a review of medical documentation, itemized bills, and claims data… more
- CVS Health (Trenton, NJ)
- …home). Standard working hours Monday - Friday 8-5 pm EST. **ICM Case Manager RN ** **WFH Flexible** **Position Summary:** Help us elevate our patient care to a whole ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...member's overall wellness. * Uses clinical tools and information/data review to conduct an evaluation of member's needs and… more
- Zurich NA (Trenton, NJ)
- …+ Experience leading operational initiatives and/or work streams Preferred Qualifications: + Licensed Registered Nurse ( RN ) in the state of residence + ... Sr Supplier Medical Process Specialist 128416 Zurich North America is...years of experience in the Nursing areaAND + Licensed registered nurse in state of residence +… more
- Otsuka America Pharmaceutical Inc. (Trenton, NJ)
- …Ability to travel up to 25%. **Educational Qualifications** Required: * Bachelor's Degree or Registered Nurse ( RN ). Minimum of 10 years industry experience ... guidance, ICH/GCP, and Otsuka SOPs. * Contribute to the development and review of all critical clinical study documents, including clinical protocols, informed… more
- CenterWell (Trenton, NJ)
- …Microsoft Access or experience with SQL Server databases + Previous experience processing medical claims + Bilingual (English and Spanish); with the ability to ... The Director Denials Management provides leadership for the audit, appeal and review process to preserve and recover revenue while maintaining the highest level… more