• Payment Integrity Clinician

    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...measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and… more
    Highmark Health (11/14/25)
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  • Change Execution Consultant

    Highmark Health (Trenton, NJ)
    **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job plays a key role in ensuring projects (ie change initiatives) meet objectives on time ... and minimize risk to implementation. Works to drive faster adoption, higher ultimate utilization and greater proficiency of the changes that impact employees in the… more
    Highmark Health (09/19/25)
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  • Senior Clinical Account Executive - Express…

    The Cigna Group (Morris Plains, NJ)
    …Develops and presents comprehensive clinical strategies - including formulary design and health management solutions - in collaboration with account executives ... several health -related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match,… more
    The Cigna Group (11/18/25)
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  • Case Manager Registered Nurse - Field in New…

    CVS Health (Moorestown, NJ)
    …high-quality, cost-effective care for our members. These strategies encompass utilization management , quality improvement, network coordination, and clinical ... At CVS Health , we're building a world of health...judgment, critical thinking, and the ability to coordinate physical, behavioral , and psychosocial services. **Key Responsibilities** + Conduct in-home,… more
    CVS Health (11/14/25)
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  • LTSS Service Coordinator - Clinician

    Elevance Health (Trenton, NJ)
    …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... the health care team, to ensure cost effective and efficient utilization of health benefits. + Decision making skills will be based upon the current needs… more
    Elevance Health (09/20/25)
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  • Sumer 2026 Analytic Enablement Graduate Intern

    Highmark Health (Trenton, NJ)
    …AI techniques, assessing their applicability to core healthcare payer operations (eg, utilization management , claims processing, member services). 3. Modeling & ... **Company :** Highmark Health **Job Description :** **SUMMARY OF JOB RESPONSIBILITIES**...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
    Highmark Health (10/28/25)
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  • Summer 2026 Quality Analytics Undergraduate Intern

    Highmark Health (Trenton, NJ)
    **Company :** Allegheny Health Network **Job Description :** Applicants must be authorized to work in the US independently. At this time, we do not offer visa ... of data, analyses, slides and preparation for CMS TEAMS and ED CT Utilization workgroups + Exposure to VBR work, including various programs, models, contracts, etc.… more
    Highmark Health (10/08/25)
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  • PCO Medical Director- UM - Full Time

    CenterWell (Trenton, NJ)
    …**Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization review ... a focus on collaborative business relationships, value-based care, population health , or disease or care management . **Use...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
    CenterWell (11/06/25)
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  • Senior Value-Based Programs Professional

    Humana (Trenton, NJ)
    …+ Administers new innovative VBP models for range of provider types, such as behavioral health , maternity, specialists, and social determinants of health , ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...move providers from volume to value. + Analyzes financial, utilization , and performance data to identify opportunities to drive… more
    Humana (11/11/25)
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  • Program Director

    Legacy Treatment Services (Northfield, NJ)
    …The Program Director will provide clinical and administrative oversight/supervision and management of the program and team, including consultation on clinical ... activities, therapeutic and behavioral assistance supports and direct on-site intervention with youth...of required data and documentation on youth access and utilization of services. Supervise the medical team, Assistant Program… more
    Legacy Treatment Services (10/23/25)
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