Utilization management jobs in Bloomfield, NJCreate job alerts

201 Third Street (61049), United States of America, San Francisco, CaliforniaDistinguished AI EngineerOverview: At Capital One, we are creating responsible and reliable AI systems, changing banking for good. For years, Capital One has been an industry leader in using machine learning to create re...

Center 3 (19075), United States of America, McLean, VirginiaSenior AI EngineerOverview: At Capital One, we are creating responsible and reliable AI systems, changing banking for good. For years, Capital One has been an industry leader in using machine learning to create real-time, personalized cu...

Performs all duties inherent in a managerial role.

Utilization Management Specialist MSH Case Management FT Days. Position responsibilities will include utilization management support functions for patient admissions and continuing stay. This position also facilitates and tracks concurrent adverse determinations and collaborates with Appeals Mana...

The Case Management Care Coordinator, Utilization Management is a member of the healthcare team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilizatio...

Supervise the management of the Denial Management System of the Utilization Management Department. Interview and hire applicants for employment into available job positions in the Utilization Management Department as well as supervise and conduct the orientation of new employees. Formulate, revie...

MetroPlusHealth Utilization Management policies, procedures, and protocols. Assists all departments with the resolution of members' problems related to utilization management issues. Performs all Utilization Management activities in compliance with all regulatory agency requirements.

Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner. Informs member and provider of Utilization Management determinations and treatment alternatives. Assists all departments with the resolutio...

The Care Manager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members. Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not...

The Market Medical Director for Utilization Management will support WellMed Medical Management, Inc. Remote working/work at home options are available for this role. Performs all duties with physicians and medical group staff in a professional and responsible manner.

Informs member and provider of Utilization Management determinations and treatment alternatives. Assists all departments with the resolution of members' problems related to utilization management issues. Performs all Utilization Management activities in compliance with all regulatory agency requi...

Coordinates with management, subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is appropriate, timely and cost effective. Ensures all records/logs related to decision requests, Notices of Ac...

Informs member and provider of Utilization Management determinations and treatment alternatives. MetroPlusHealth Utilization Management policies, procedures, and protocols. Performs all Utilization Management activities in compliance with all regulatory agency requirements.

A traveler facility in Bronx, NY is seeking its next amazing RN (Registered Nurse) to work in Case Management (Utilization Review).

CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every m...

The Utilization Management Registered Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Previous experience in ut...

CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every m...

Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc. Informs member and provider of Utilization Management determinations and treatment alternatives. Assists all departments with the resolut...

Precertification: Utilization Management Nurse Consultant -SCPU. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Prior Authorization or Utilization Management experience.

Care Management, Care Coordinator, Utilization Management. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of stay, promote efficient utilization of resources and ensure that care meets evidence-based practice...

Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc. Informs member and provider of Utilization Management determinations and treatment alternatives. Performs all Utilization Management acti...

The Director of Utilization and Case Management will spearhead the strategic direction, management, continuous improvement, and overall maintenance of the Utilization and Case Management Services Unit. Lead the Utilization and Case Management Department at University Hospital, a prestigious healt...

Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of stay, promote efficient utilization of resources and ensure that care meets evidence-based practice standards and regulatory/payor requirements and follows th...

The Director of Utilization and Case Management will spearhead the strategic direction, management, continuous improvement, and overall maintenance of the Utilization and Case Management Services Unit. Lead the Utilization and Case Management Department at University Hospital, a prestigious healt...