Utilization review jobs in Clifton, NJCreate job alerts

POSITION SUMMARY: To coordinate and facilitate patient care through the Valley Hospital Health Care System as it relates to a multidisciplinary approach to patient care and utilization of resources. EDUCATION: Bachelor's degree required. ANCC case management certification preferred. EXPERIENC...

POSITION SUMMARY: Performs concurrent utilization review activities on all patients within the assigned caseload. Collaborates and educates the medical staff on appropriate utilization review guidelines and documentation in accordance with CMS regulations and Commercial payors guidelines. Monito...

POSITION SUMMARY: To coordinate and facilitate patient care through the Valley Hospital Health Care System as it relates to a multidisciplinary approach to patient care and utilization of resources. EDUCATION: Bachelor's degree required. ANCC case management certification preferred. EXPERIENC...

POSITION SUMMARY: Performs concurrent utilization review activities on all patients within the assigned caseload. Collaborates and educates the medical staff on appropriate utilization review guidelines and documentation in accordance with CMS regulations and Commercial payors guidelines. Monit...

Concentra is seeking a Registered Nurse (RN) Med Surg / Telemetry for a nursing job in Secaucus, New Jersey. Job Description & Requirements - Specialty: Med Surg / Telemetry - Discipline: RN - Duration: Ongoing - Employment Type: Staff \nOverview:\n Are you an accomplished Board Certified...

LocumJobsOnline is working with CompHealth to find a qualified Hospitalist MD in Salem, New Jersey, 08079! Pay Information $250,000 per year About The Position Come practice in Salem, NJ. Salem is located along the Salem River, with access to water and upgraded railways to support current and f...

Job DescriptionAssociate Director, Manufacturing OperationsAllendale, NJ Lynkx Staffing LLC specializes in placing talented professionals in the Biotechnology, Pharmaceutical and Medical Devices industries in New Jersey. The Associate Director, Manufacturing Operations is responsible for efficien...

Job DescriptionBenefits: - 401(k) matching - Competitive salary - Flexible schedule - Paid time off - Training & development POSITION SUMMARY: Leads field staff in delivering exceptional client service, clinical care, quality, and adherence to policies and procedures. Accountable for inter...

Job Description Building a HEALTHIER COMMUNITY Hudson Regional Hospital is the premier hospital providing comprehensive care to Northern New Jersey. Our mission is to build a healthier community through exceptional care, sophisticated technology, and knowledgeable physicians. Hudson Regional H...

Job Description RN Director of Case Management Greater Newark Area, New Jersey The RN Director of Case Management will interface with physicians, finance and nursing team members to meet organizational and corporate goals of both the hospital and the Case Management Department. The Director o...

Job Description Vivo HealthStaff is recruiting for a Utilization Review Physician based in New Jersey for a Managed Care Insurance Plan. This position requires 4 days per month on-site. The Utilization Review Physician is the lead clinician for the health plan. Responsible for the administration...

Job DescriptionCompany Description Discovery Behavioral Health (DBH) is a national leader in behavioral healthcare and one of the fastest growing companies in the field. DBH offers world-class treatment for those struggling with eating, mental health, and substance use disorders, and places a h...

Job DescriptionSummary Our health and human service agency client in Nutley, NJ, is seeking a Director of Outpatient Services for their organization. This pivotal role will be vital in providing oversight of their mental health outpatient program. This position ensures the integration of the agen...

***$15,000 Sign-on Bonus Available for qualified candidate! *** Leadership experience 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....

Job Description CoreWeave is the AI Hyperscaler™, delivering a cloud platform of cutting edge services powering the next wave of AI. Our technology provides enterprises and leading AI labs with the most performant, efficient and resilient solutions for accelerated computing. Since 2017, CoreWeave...

About Wakefern Wakefern Food Corp. is the largest retailer-owned cooperative in the United States and supports its co-operative Members' retail operations, trading under the ShopRite®, Price Rite®, The Fresh Grocer®, Dearborn Markets®, Fairway Markets®, Gourmet Garage®, and Di Bruno Bros.® banne...

Job Description Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neig...

Job DescriptionSalary: Phillip Jeffries is looking for a leader to join our Supply Chain Team! The Director, Manufacturing plays a critical role in driving operational excellence and product quality across our manufacturing operations. This leader will oversee daily production, implement le...

Job DescriptionCompany Description From the inception of a project through to completion and beyond, Turner & Townsend help to deliver the outcomes that matter through transformational projects covering the full spectrum of consultancy, project delivery and post-project operations. With offi...

Job DescriptionDescription: Founded in 2005, ASun Star provides services to individuals (adolescent, adult) and families within the our facility and the families’ home, school, and community. We utilize a strength-based approach and are dedicated to helping our families succeed within their respe...

Job DescriptionCompany Description A subsidiary of Veolia group, Veolia North America (VNA) is the top-ranked environmental company in the United States for three consecutive years, and the country’s largest private water operator and technology provider as well as hazardous waste and pollution...

Job Description Summary: The Logistics Manager will oversee a busy distribution center environment, including process improvement, team development, and supply chain management. This position directs all operations activities in a distribution center environment. Responsibilities include oper...

Job DescriptionPPG is a sister company of QISG under the parent Quanta Services, Inc. This posting is for a direct hire position of Phoenix Power Group and is solely for the purpose of Phoenix Power Group. Phoenix Power Group (PPG) is a leading Construction Services Company providing Engineering...

Job DescriptionDescription: Agency Overview: Join a dynamic team focused on providing top notch Behavior Analysis to children and adolescents. Enjoy a more productive and easy-going company culture that's focused on ensuring the success of it's talent on all levels. ASun Star is known for en...

Job Description Job Title: Senior Manager Financial Planning & Analysis Classification: Full Time, Salary, Exempt Department: Finance & Accounting Location: Kearny, NJ Job Summary: We are seeking a seasoned and strategic Senior Manager of FP&A to lead our budgeting, forecasting, cost analysi...

Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers’ compensation claims. Concentra is seeking a Regis...

Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers’ compensation claims. Our integrated health and we...

Job DescriptionSalary: MAINTENANCE MECHANIC This position is responsible for maintaining the physical integrity of the property at all times. This involves insuring a safe and secure living environment for residents, visitors and staff. It is the duty of the Maintenance Mechanic to follow al...

Formulary Strategy & Utilization Review Pharmacist.

ANCC case management certification preferred. Minimum five years experience in utilization review management and/or case management preferred. Ability to use critical thinking and clinical reasoning skills effectively problem-solve and provide case management services.

These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and transitions of care, as outlined in the responsibilities below. Supports & Participates in pre-admission review, utilization management, and concurrent and. At least two year...

Supports & Participates in pre-admission review, utilization management, and concurrent and retrospective review process. At least two years experience in Utilization Review processes including knowledge of. These include but are not limited to utilization review, hospital reimbursement, clinical...

Performs concurrent utilization review activities on all patients within the assigned caseload. Monitors and intervenes on LOS, resource utilization and denial management/ prevention within the assigned caseload. Minimum 5 years'"¢ experience in clinical nursing, minimum of 3 years in case mana

Monogram Health is seeking a skilled and compassionate full-time Nephrologist to join our team in delivering value-based care to patients with kidney diseases. The ideal candidate will be passionate about improving patient outcomes for patients with kidney disease, reducing healthcare costs, and...

Job Description Daughters of Israel is a non-profit skilled nursing facility. We are currently seeking a Director of Social Services to oversee and ensure that the medically related emotional and social needs of the residents are met on an individual basis. Responsibilities: - Oversee all aspe...

Job Description The Service Technician is accountable for troubleshooting malfunctioning or disabled automated, anti-vehicular barrier and bollard equipment to determine root cause of malfunction or failure and taken appropriate action to return the equipment to operational condition. The Servi...

Job Description Daikin Comfort Technologies Northeast is seeking a professional, skilled individual for our HVAC Branch Manager position for our branch operations group. The Branch Manager 1 oversees the branch’s operations and staff with accountability for sales (<$25 million), customer service,...