- St. Luke's University Health Network (Phillipsburg, NJ)
- …The RN Care Manager coordinates the overall progression of care, resource utilization , and discharge planning for designated patient populations across the continuum ... management, including but not limited to: Social workers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among all… more
- Chatham Hills Subacute Care Center (Chatham, NJ)
- Schedule . 5 days a week 37.5 - 40 hours per week Respiratory Nurse (RN) We are searching for a highly motivated, flexible, organized, skilled respiratory therapist ... meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training sessions. +… more
- Elevance Health (Woodbridge, NJ)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... the assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of… more
- Evolent (Trenton, NJ)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and procedures.… more
- CVS Health (Clark, NJ)
- …high-quality, cost-effective care for our members. These strategies encompass utilization management, quality improvement, network coordination, and clinical policy ... upon achieving proficiency in the role. **Required Qualifications** + Active, unrestricted **Registered Nurse (RN) license in New Jersey** . + Minimum of **3 years… more
- Hackensack Meridian Health (Edison, NJ)
- …program and its Quality Metrics. + Knowledge of health care delivery system, utilization and review and case review procedures. + Knowledge of Social Determinants of ... EPIC. **Licenses and Certifications Required** : + NJ State Professional Registered Nurse License. + AHA Basic Health Care Life Support HCP Certification. **Licenses… more
- Fresenius Medical Center (Flemington, NJ)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... Responsible for all required network reporting and on-site state or federal surveys. PATIENT CARE: + Coordinates all aspects of patient care with the appropriate staff members, from admission through discharge of the patient. + Ensure education of the patient… more
- Fresenius Medical Center (Teaneck, NJ)
- …supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve ... supply cost goals following all guidelines established in FMS formularies + Participates in the completion and interpretation of the Pl-17 inventory supply use analysis. + Reviews and approves facility payroll. + Reviews profit and loss statements with… more
- US Tech Solutions (Branchburg, NJ)
- …an **acute/critical care** unit, organ donation/transplant unit, in tissue/blood banking, utilization review and/or case management with critical care skill set ... knowledge preferred * CTBS Certified or willing to obtain within two years of employment **Essential Skills, Experience, and Competencies** Understanding & Recognizing (but not limited) the following: * physical assessment findings * history & physical reports… more
- Elevance Health (Morristown, NJ)
- …will make an impact:** + Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care. + Perform ... physician-level case review, following initial nurse review, of chemotherapy regimens. + Determine medical necessity of requests using guidelines and client-specific… more