- CVS Health (Trenton, NJ)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Trenton, NJ)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- US Tech Solutions (Hopewell, NJ)
- …case/care management principles. - Prefers working knowledge of principles of utilization management . - Prefers basic knowledge of health care contracts and ... duties and types of care management as assigned by management .** **Responsibilities:** 1. Assesses patient's clinical need against established guidelines… more
- CVS Health (Trenton, NJ)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Hackensack Meridian Health (Brick, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Evolent (Trenton, NJ)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Fresenius Medical Center (Kenilworth, NJ)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions...the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member… more
- Virtua Health (Marlton, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... Locations: Job Information: *Current board certification as WOC (ET) nurse (CWOCN) by the Wound, Ostomy and Continence Nursing...determine the types of services to be provided. Case management nurses provide education in disease management … more
- Fresenius Medical Center (Union, NJ)
- …required!!_** **_ Dialysis Training Provided _** **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient ... care is delivered while maintaining clinical operations. As the facility leader, you will be...Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and… more
- Sharecare (Trenton, NJ)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more