Utilization management rn jobs in Elizabeth, New JerseyCreate job alerts

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The RN Clinical Care Coordinator will be the primary care manager for a panel of members with complex medical/behavioral needs. Care coordination activities will focus on supporting member's medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. Expect to spend about 80% of your time in the field visiting our members in their homes or in long-term care facilities. You'll need to be flexible, adaptable and, above all, patient in all types of situations. Do you live or are you willing to travel to any of the following counties? Hudson and Surrounding Counties, NJ Primary Responsibilities: • Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs, • Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines, • Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan, • Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health, • Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission, • Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: • Current, unrestricted independent licensure as a Registered Nurse, • 2+ years of clinical experience, • 1+ years of experience with MS Office, including Word, Excel, and Outlook, • BSN, Master's degree or higher in clinical field, • CCM certification, • 1+ years of community case management experience coordinating care for individuals with complex needs, • Experience working in team-based care, • Background in managed care Physical Requirements: • Ability to transition from office to field locations multiple times per day, • Ability to navigate multiple locations/terrains to visit employees, members and/or providers, • Ability to transport equipment to and from field locations needed for visits (ex. laptop, stethoscope, etc.), • Ability to remain stationary for long periods of time to complete computer or tablet work duties Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Prime Staffing is seeking a travel nurse RN Acute Care Case Management for a travel nursing job in Summit, New Jersey. Job Description & Requirements • Specialty: Acute Care Case Management, • Discipline: RN, • Start Date: 12/15/2025, • Duration: 13 weeks, • 36 hours per week, • Shift: 12 hours, • Employment Type: Travel About the Position Specialty: RN Case Manager Experience: 1+ year of recent case management or discharge planning experience preferred License: Active State or Compact RN License Certifications: BLS – AHA Must-Have: Strong assessment, discharge planning, and utilization review skills \n Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with providers, social workers, and external agencies to ensure timely, efficient, and effective discharge planning and transitions. Supports utilization management and ensures compliance with payer guidelines. Onboarding typically takes 2–4 weeks based on documentation and clearance processes. \n \n Requirements \n Required for Onboarding: \n\n • Active RN License\n We offer a wide range of staffing services including temporary, temp-to-perm, and direct hire placements. Our extensive network of qualified candidates includes nurses, allied healthcare professionals, corporate support professionals and executives.

CEAP, LMSW, LCSW, LPC, RN) Minimum of 2 years of experience in healthcare, behavioral health, or substance abuse settings Knowledge of utilization management procedures and community resources Experience in inpatient and/or outpatient settings Understanding of DSM V or the most current diagnosti

Job Description POSITION SUMMARY: We are seeking an experienced Licensed Practical Nurse who is energetic and passionate about helping and working with a multi-specialty clinic with diverse patient population. The Licensed Practical Nurse will work under the supervision of the Nurse Manager to evaluate, triage patients for clinical care of the Healthcare providers. Will support our healthcare team, and contribute to the success of our organization ESSENTIAL DUTIES AND RESPONSIBILITIES: • Patient Care:, • Provide direct patient care under the supervision of a Registered Nurse (RN) or Physician (MD)., • Take vital signs, administer medications, and perform various medical procedures., • Monitor patients' conditions, report changes to the RN or Provider, and implement care plans., • Help Link new and established patients to care services, including case management, partner services, medical care, social programs, and education., • Clinical Support:, • Assist RNs, Nurse Manager and Providers with exams, procedures, and other medical tasks., • Carry out intakes and bio-psychosocial assessments for clients, • Prepare patients for exams, tests, and procedures., • Maintain accurate and up-to-date patient records., • Participate in off-site community outreach events., • Administer injections and medications onsite or at offsite outreaches as prescribed by the provider., • Monitor, coordinate, and administer vaccinations, • Communication and Collaboration:, • Communicate effectively with patients, families, and healthcare team members., • Collaborate with RNs, MDs, and other healthcare professionals to provide comprehensive care., • Participate in multidisciplinary team meetings and contribute to care planning., • Assists in the coordination of services with SJH Case Managers, other disciplines and patient's insurance plans., • Advocates for patient in arrangement of medically necessary services., • Quality Improvement and Safety:, • Participate in quality improvement initiatives and patient safety efforts., • Identify and report potential safety hazards or quality concerns., • Implement evidence-based practices and follow organizational policies and procedures., • Adhere to SJH safety, policies, procedures and regulations, • Maintain current professional certifications and licensures, • Administrative Tasks:, • Manage patient flow, prepare exam rooms, and maintain a clean and organized work environment., • Answer phone calls in relations to patient care, respond to patient inquiries, and provide general administrative support., • Provide crisis intervention as assistance as instructed by the RN, Nurse manager and Provider as needed., • Monitor and coordinate medical care and insurance authorization, • Prepare data reports for external agencies and clinic management, • Maintain accurate clinical documentation in electronic medical records (EMR), • Ensure and Maintain adequate patient records, track service, referrals, due dates, and identify potential beneficiaries. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. QUALIFICATIONS: • Minimum 3-years of experience as Licensed Practitioner Nurse, • Licensed Practical Nurse NJ State/Multi Compact License (Required)., • Highly organized with an attention to detail, • Excellent interpersonal skills with patient and co-workers, • Basic CPR (BCLS) certification (Required)., • Phlebotomy Skills (Required)., • Bilingual/ fluent in Spanish (Preferred)

A company is looking for an RN Utilization Management remote. Key Responsibilities Participates in designated committees and task forces related to the Utilization Management Program Coordinates with various departments and staff regarding case management issues Documents and communicates qualit

Key Responsibilities Implement, coordinate, monitor, and evaluate medical review cases using clinical experience Apply clinical criteria and guidelines to make medical determinations for clients Assist in training new nurse reviewers and recommend process improvements to enhance quality and clie

Role Overview We’re seeking experienced Utility Management Nurses to support a client’s healthcare product development by leveraging expertise in insurance coding and hospital revenue management workflows. This role involves collaborating with hospital systems to align medical documentation with insurance policies, ensuring accurate coding and optimal reimbursement outcomes. ### Key Responsibilities - Insurance Coding & Revenue Cycle Alignment: Review, audit, and optimize insurance coding practices across hospital systems to ensure compliance and maximize reimbursement accuracy. - Workflow Analysis: Evaluate existing revenue management workflows and recommend improvements tailored to client’s AI-driven documentation tools. - Clinical Data Interpretation: Translate complex clinical notes into standardized coding formats (ICD-10, CPT, HCPCS) aligned with payer policies. - Policy Matching: Assess coding accuracy against insurance guidelines and payer documentation requirements. - Product Development Collaboration: Work closely with client’s engineering and product teams to refine AI models that automate or assist with medical coding and documentation. - Compliance & Quality Assurance: Ensure alignment with HIPAA, CMS, and payer-specific coding regulations. ### Required Qualifications - Licensure: Registered Nurse (RN) or equivalent clinical background. - Experience: Minimum 3–5 years in medical coding, clinical documentation improvement (CDI), or revenue cycle management. - Certifications: CPC, CCS, or CRC certification preferred. - Domain Expertise: Familiarity with hospital billing systems, payer policy interpretation, and coding audit procedures. - Analytical Skills: Strong understanding of clinical documentation standards and payer logic. - Tech Savvy: Comfortable working with EHR systems (Epic, Cerner, Meditech) and documentation review software. ### Preferred Qualifications - Experience working within hospital revenue integrity teams or insurance utilization management. - Exposure to AI-powered healthcare documentation tools or automated coding systems. - Ability to identify and flag edge cases or policy exceptions in automated workflows. - Strong collaboration skills with cross-functional (engineering, compliance, and data) teams. ### Engagement Model - Contract / Part-time (Remote/In person) — Flexible hours with collaboration during U.S. business hours. In person in San Francisco is a plus

Internal Contacts: Direct Patient Care Staff, Facility support staff, management teams (Clinical Manager, Area Manager, RVP). RN charge nurses assuming responsibility for nursing and patient services in the absence of the Clinical Manager must have one-year clinical experience and six months dialysi

Registered Nurse - RN NICU | Registered Nurse - RN in Glen Ridge, NJ. LeaderStat is currently seeking a Registered Nurse - RN with NICU | Registered Nurse - RN experience for a(n) 13 week contract in NJ. LeaderStat is seeking a travel nurse RN NICU - Neonatal Intensive Care for a travel nursing job

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).

Our team of CRNAs at Weill Cornell provide patient-centered anesthesia for all types of surgical procedures, including cardiac, vascular, neurosurgery, pediatrics and obstetrics. Certified Registered Nurse Anesthetist - CRNA - Weill Cornell Medical Center - SIGN ON BONUS AVAILABLE. Our CRNA’s have

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).

Certified Registered Nurse Anesthetist - CRNA - Columbia University Irving Medical Center. Our team of CRNAs at Columbia University Irving Medical Center provides patient-centered anesthesia for all types of surgical procedures, including cardiac, vascular, neurosurgery, and pediatrics. Here at NYP

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).

Lead project execution from site mobilization to final turnover. Proficiency with construction management software and Microsoft Office Suite.

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).

Certified Registered Nurse Anesthetist - CRNA – NYP/Westchester-. At NewYork-Presbyterian Hospital, Certified Registered Nurse Anesthetists (CRNAs) deliver incredible care that is unseen anywhere else in the world. Our team of CRNAs at Westchester Hospital provide patient-centered anesthesia for a

Requirements for Registered Nurses (RN). Valid New Jersey RN License or Multistate License. With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatr

Registered Nurse Unit Manager, RN will assist other staff members in completion of their duties. Intrinsic to each facility in the EPIC portfolio are the words Rehabilitation & Healthcare, as our overriding goal is to rehabilitate patients and successfully return them to their lives. Communicate ong

Requirements for Registered Nurses (RN). Valid New Jersey RN License or Multistate License. With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatr

Experience : Considerable (at least 5 years) experience is necessary in related management positions.

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).

Earn up to $750 per week part-time working from home. This is a great way to earn additional income from the comfort of your home. Must have access to high speed internet connection.

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).

All staff must bring to the organization the traits necessary to nurture our internal and external relationships. All staff must bring to the organization the traits necessary to nurture our internal and external relationships. RN with a bachelor’s degree in health/human services; or.

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).

All staff must bring to the organization the traits necessary to nurture our internal and external relationships. All staff must bring to the organization the traits necessary to nurture our internal and external relationships. The Case Manager must have very strong interpersonal skills and the abil

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. Williamsbridge Center is hiring a Registered Nurse (RN) for our Skilled Nursing Facility in Bronx, NY. As a Registered Nurse (RN), Provide advice & support to the Residents and their families.

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).

Registered Nurse Unit Manager, RN coordinates resident care in accordance with State DOH regulations. Monitor and evaluate the flow of activity and delivery of patient care provided by the CNA's (turning and positioning, mealtimes, bathing, etc. Registered Nurse Unit Manager, RN will assist other st

Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN). Valid New Jersey RN License or Multistate License.

Experience : Considerable (at least 5 years) experience is necessary in related management positions.

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).

All staff must bring to the organization the traits necessary to nurture our internal and external relationships. All staff must bring to the organization the traits necessary to nurture our internal and external relationships. The Case Manager must have very strong interpersonal skills and the abil

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. Ideal candidates should possess a current RN license, long-term care experience, strong communication skills, and be able to work effectively in a team environment. Williamsbridge Center is hiring a Registered Nurse

Valid New Jersey RN License or Multistate License. With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatric health services, including pediatric n

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. Williamsbridge Center is hiring a Registered Nurse (RN) for our Skilled Nursing Facility in Bronx, NY. As a Registered Nurse (RN), Provide advice & support to the Residents and their families.

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. The role requires a current RN license, excellent communication, and teamwork skills, with a preference for candidates with long-term care experience. Williamsbridge Center is hiring a Registered Nurse (RN) for our

Valid New Jersey RN License or Multistate License. With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatric health services, including pediatric n

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. As a Registered Nurse (RN), Provide advice & support to the Residents and their families. Current State Registered Nurse RN License.

Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN). Valid New Jersey RN License or Multistate License.

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. As a Registered Nurse (RN), Provide advice & support to the Residents and their families. Current State Registered Nurse RN License.

With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatric health services, including pediatric nursing and therapies, ABA therapy, nursing, Family

Registered Nurse Care Manager / Case Management (RN) at Centers Healthcare summary:. The Registered Nurse Care Manager (RN) at Williamsbridge Center provides essential support and care to residents in a skilled nursing facility. Williamsbridge Center is hiring a Registered Nurse (RN) for our Skilled

Benefits for Registered Nurses (RN). Responsibilities of Registered Nurses (RN). Requirements for Registered Nurses (RN).