- Hackensack Meridian Health (Edison, NJ)
- …expert computer skills. + Familiar with hospital resources, community resources, and utilization management . + Excellent written and verbal communication skills. ... a leader of positive change. The **Care Coordinator, Care Management ** is a member of the healthcare team and...Knowledge, Skills and Abilities Required: + Bachelor's Degree in Nursing or related field, or Master's Degree in Social… more
- Highmark Health (Trenton, NJ)
- … **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- CVS Health (Trenton, NJ)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- RWJBarnabas Health (Elizabeth, NJ)
- …family education, clinical and financial prerequisites, pre-certification, verification of benefits, utilization management , and patient / family communication + ... Essential Functions: + Assumes responsibility for the operation and management of the department in the absence of the...and accurate bed assignment + Ensures patient, physician, and nursing needs are met while maintaining alignment with the… more
- CVS Health (Moorestown, NJ)
- …high-quality, cost-effective care for our members. These strategies encompass utilization management , quality improvement, network coordination, and clinical ... and support needs, including adult/pediatric medical daycare, personal care assistants, nursing facility services, and MLTSS enrollment. + Collaborate with members,… more
- Evolent (Trenton, NJ)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... to perform the essential functions. **EDUCATION and/or EXPERIENCE:** Master of Science in Nursing or Doctor of Nursing Practice (DNP) degree from a recognized… more
- Penn Medicine (Plainsboro, NJ)
- …timely and accurate information to payors. The role integrates and coordinates utilization management , care facilitation and discharge planning functions. In ... **Responsibilities:** + Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to… more
- Penn Medicine (Princeton, NJ)
- …Effective and timely completion of pre-certifications as well as coordination of utilization reviews with utilization management reviewer. Timely and ... individuals to join an interdisciplinary team of therapists, dieticians, nursing , milleu coordinators, and psychiatric providers to deliver evidence-based care.… more
- Elevance Health (Woodbridge, NJ)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… 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 ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more