- 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 ... **Become a part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers… more
- Highmark Health (Trenton, NJ)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving key technical ... They function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed technical requirements for… more
- Magellan Health Services (Trenton, NJ)
- …with parents, personnel, schools, and consultation to installation command regarding behavioral health issues affecting children and youth. CYB School ... - Required Clinical Work Experience - Preferred Education - Required Master's - Behavioral Health , Master's - Social Work Education - Preferred License and… more
- Highmark Health (Trenton, NJ)
- …effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource ... utilization , identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors 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 ... design efforts. + Develop and foster relationships across Highmark and with professional organizations, user groups and industry trade groups to stay current with… more
- Atlantic Health System (NJ)
- …an Advanced Comprehensive Stroke Center. Additional Joint Commission-certified services include behavioral health care, spine surgery, wound care, and primary ... supplies/charts. + Participates in cost containment measures by appropriate utilization of supplies/resources. + Dismantles charts and assures all… more
- Atlantic Health System (Clark, NJ)
- …an Advanced Comprehensive Stroke Center. Additional Joint Commission-certified services include behavioral health care, spine surgery, wound care, and primary ... and planar Xray procedures on patients according to state, federal, professional and departmental standards and guidelines. + Reviews each requisition/questionnaire… more
- Highmark Health (Trenton, NJ)
- …SUMMARY** This job requires the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and… more
- Elevance Health (Jersey City, 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...our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors… more
- Hackensack Meridian Health (Edison, NJ)
- …University Medical Center and Palisades Medical Center. Experience working within Behavioral Health is strongly preferred. **Education, Knowledge, Skills and ... communicating and facilitating the care of patients with Medical, Behavioral and Maternal Health needs. The navigator...Jersey program and its Quality Metrics. + Knowledge of health care delivery system, utilization and review… more