- Humana (Trenton, NJ)
- …of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support ... services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license,… more
- CVS Health (Moorestown, NJ)
- …new hires upon achieving proficiency in the role. **Required Qualifications** + Active, unrestricted ** Registered Nurse ( RN ) license in New Jersey** . + ... high-quality, cost-effective care for our members. These strategies encompass utilization management , quality improvement, network coordination, and clinical… more
- CenterWell (Trenton, NJ)
- … RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
- BriteLife Recovery (Englewood, NJ)
- …you? + Minimum of 2-3 years of experience in utilization review, case management , or insurance coordination in a behavioral health or substance use treatment ... compliance. + Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials, approvals,… more
- Elevance Health (Woodbridge, NJ)
- …unless an accommodation is granted as required by law._ " The **LTSS Service Coordinator- RN ** is responsible for overall management of member's case within the ... **LTSS Service Coordinator - RN ** **Location:** The location for this position includes...face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral… more
- Atlantic Health System (Summit, NJ)
- …selected member populations across the continuum of illness. Ensures effective utilization and monitors health care resources. Manages the interdisciplinary team to ... clinical and resource outcomes. Works with the Supervisor/Manager of Case Management to assess, plan, implement, coordinate, monitor and evaluate services and… more
- Sharecare (Trenton, NJ)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the… more
- Highmark Health (Trenton, NJ)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- Highmark Health (Trenton, NJ)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... be obtained within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case … more
- Elevance Health (Trenton, NJ)
- …telephonic or face-to-face assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral ... is responsible for working under the direction/supervision of an RN , with overall responsibility for the member's case. As...health care team, to ensure cost effective and efficient utilization of health benefits. + Decision making skills will… more