• Utilization Management Clinical…

    CVS Health (Trenton, NJ)
    …working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal departments. + ... management program. + Conduct clinical reviews for adult inpatient behavioral health cases, applying established medical necessity criteria to ensure… more
    CVS Health (11/19/25)
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  • Utilization Review Specialist

    BriteLife Recovery (Englewood, NJ)
    …in utilization review, case management , or insurance coordination in a behavioral health or substance use treatment setting. + Knowledge of ASAM criteria ... and a working knowledge of insurance guidelines specific to behavioral health What tasks are required? +...Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in… more
    BriteLife Recovery (11/03/25)
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  • Behavioral Health Medical Director…

    Humana (Trenton, NJ)
    …value-based care, quality metrics, population health , and disease or care management . The Behavioral Health Medical Director may develop procedures, ... part of our caring community and help us put health first** The Behavioral Health ...management , utilization management , case management , discharge planning and/or home health or… more
    Humana (11/11/25)
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  • Behavioral Health Clinician…

    Atlantic Health System (Morristown, NJ)
    The Behavioral Health Clinician position in our Collaborative Care Program serves as an integrated member of the team at our Internal Medicine Faculty ... and families on diagnoses, treatment options, relapse prevention, and self- management strategies. 04. Provides brief, evidence-based behavioral interventions… more
    Atlantic Health System (10/04/25)
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  • Employee Assistance Program Management…

    CVS Health (Trenton, NJ)
    … Management background preferred. **Education** + Master's degree in behavioral health field. **Anticipated Weekly Hours** 40 **Time Type** Full ... **Required Qualifications** + Unrestricted independent state licensure in a behavioral health field (LMHC, LMFT, LCSW, LICSW,...+ Human Resource and/or Supervisory experience. + Case management , Utilization Review, or Utilization… more
    CVS Health (11/13/25)
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  • Medical Director, Medical Management

    Highmark Health (Trenton, NJ)
    …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
    Highmark Health (10/28/25)
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  • Pharmacist - Case and Disease Management…

    Highmark Health (Trenton, NJ)
    …residency program + 5 - 7 years in Pharmacy + 3 - 5 years in Pharmacist - Utilization Management + 3 - 5 years in Pharmacist - Medical Therapy Management ... are transitioned to a Pharmacist for Case & Disease Management (CMDM). The incumbent then conducts thorough research to...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
    Highmark Health (11/15/25)
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  • Transplant Care Nurse (Remote)

    Highmark Health (Trenton, NJ)
    …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
    Highmark Health (11/06/25)
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  • Physician Advisor, Overlook Medical Center

    Atlantic Health System (Summit, NJ)
    …an Advanced Comprehensive Stroke Center. Additional Joint Commission-certified services include behavioral health care, spine surgery, wound care, and primary ... Atlantic Health is Seeking a Physician Advisor in Summit,...management strategies, practice guideline development and application, risk management principles + Utilization -specific training from ABQAURP… more
    Atlantic Health System (11/17/25)
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  • Senior Decision Support Consultant

    Highmark Health (Trenton, NJ)
    …impact corporate performance + Researches, manipulates, and prepares data related to Health Management programs that document program activities and the results ... the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role...of Health Management… more
    Highmark Health (11/14/25)
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