- Highmark Health (Trenton, NJ)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The… more
- Sharecare (Trenton, NJ)
- …and objectives of the Disease Management program by providing high quality telephonic and omni - channel support in an appropriate, efficient and cost-effective ... nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Atlantic Health System (Morristown, NJ)
- …the patient experience, achieve better health outcomes, decrease avoidable cost and utilization , and increase the utilization of preventative care and healthy ... needs, values, and goals of the patient. Provide individual telephonic /virtual support and counseling to patients, using appropriate therapeutic techniques… more
- NJM Insurance (Trenton, NJ)
- …Workers' Compensation line of business by performing prospective and retrospective Utilization Review of pharmaceutical/medication requests in accordance with ... and causally related. + Evaluate requests that are routed for clinical review based upon established criteria to issue appropriate and timely determinations on… more
- CVS Health (Trenton, NJ)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- CVS Health (Maple Shade, NJ)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... appropriate under the direct supervision of a licensed pharmacist + Taking telephonic prescriptions from the prescriber, and calling the prescriber to clarify… more