Utilization management jobs in Wayne, NJCreate job alerts

Entity: Customers & Products Job Family Group: Business Support Group Job Description: As part of the Castrol Americas Customer Excellence & Operations team, this role will be responsible  for the  management of Castrol’s Installer Management Interface (IMI) rebates platform.  This will entail...

Medical management, care management, utilization management, and quality improvement tools and processes. The Medical Director's primary duties are focused on the management of their teams. The primary responsibility for the Medical Director is direct management, oversight, and coaching of the lo...

Calling all healthcare rockstars! Are you a RN (Registered Nurse) with experience in Case Management (Utilization Review) If so, you might be the right fit for this travel healthcare position in Bronx, NY.

Informs member and provider of Utilization Management determinations and treatment alternatives. Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc. Conducts medical record reviews as appro...

Precertification: Utilization Management Nurse Consultant - SCPU.

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

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...

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 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...

Precertification: Utilization Management Nurse Consultant. 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.

Active New York State Licensed Practical Nurse (LPN) or Registered Nurse (RN) license. Utilization Management Nurse (MLTC Focus). Remote, New York (Active NY nursing license required).

Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process. Nurse Medical Management II - Utilization Management. Ensures medically appropriate, high quality, cost effective care through as...

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

To excel as the Director of Utilization Management at VillageCare, you must possess. Director of Utilization Management. This role will require you to lead a team of utilization management professionals, provide guidance on complex cases, and communicate effectively with stakeholders.

Case Management (Utilization Review).

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works ...

Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care ...

The working Supervisor of Case Management is responsible for providing supervision to the Case Managers, Coordinators, and Discharge Planners. Provides oversight for the quality and resource ...

Experience Minimum five years experience in utilization review management and/or case management preferred. Minimum of 5 years experience as a registered nurse required. Special Skills Registered ...

This partnership will provide a comprehensive clinical resource management program that includes utilization management, progression of care management, social work services, and complex discharge ...

Experience Minimum five years experience in utilization review management and/or case management preferred. Minimum of 5 years experience as a registered nurse required. Special Skills Registered ...

... and utilization management that promotes positive patient outcomes (for example but not limited to, therapy utilization, client no visit, missing TIF OASIS, agent visit time, missed visit ...