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Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required.
$93,000 a yearPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Cliffside Park, New Jersey.
Full-timeExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Coordinate and ensure that, on a timely basis, all staff of the Utilization Management Department complete their Online or In-Person Annual In-Service Training and other mandated training for NYC Health + Hospitals/Lincoln employees.
Full-timeExpandApply NowActive JobUpdated 29 days ago - UpvoteDownvoteShare Job
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Provides telephonic clinical care management services using evidence-based practices to ensure effective utilization of benefits, services, and care is provided to the patients allowing them to remain safely in their home/community.
ExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Coordinates care with family and other community service providers or collaterals including, but not limited to: hospitals, housing providers, shelter staff, criminal justice personnel, Assisted Outpatient Treatment (AOT), and primary health care providers.
Full-timeExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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Key Words: RN Travel, Travel Nurse, Contract Nurse, Agency Nurse, Travel Contract, Travel Nursing, Case Manager, Case Management, Utilization Review, Case Manager RN. The role of the case management nurse (RN) is to coordinate continuity of care for patients often as a liaison between the patient's family and healthcare organization.
$2,836 a weekExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Collaborate with an inter-professional team, including but limited to; physicians, nurses, nutrition, physical therapy and select wound care team members, to ensure smooth day-to-day operations within respective team, ensure high quality care, proper hand-off communication and effective and efficient resource utilization.
Full-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Responsibilities: Program Development and Management: Lead the development, implementation, and evaluation of nurse residency programs across various specialties (Med/Surg, Critical Care, Maternal Child Health, NICU, Emergency Services.
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Oversee the implementation of the Elsevier Transition to Practice Platform and OVID Synthesis, ensuring effective utilization and user support. Conduct periodic reviews of program resources and budgets, optimizing resource allocation and utilization.
Part-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Lead the development, implementation, and evaluation of nurse residency programs across various specialties (Med/Surg, Critical Care, Maternal Child Health, NICU, Emergency Services). Lead the development, implementation, and evaluation of nurse residency programs across various specialties (Med/Surg, Critical Care, Maternal Child Health, NICU, Emergency Services.
$191,166 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Follows departmental workflows for utilization review activities including admission reviews, admission denials, continued stay reviews, continued stay denials, termination of benefits, communication of information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews.
Full-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Preferred Qualifications: Minimum two (2) years of RN experience in utilization review, ambulatory case management, care coordination or disease management. The Liaison Nurse collects data and provides input to leadership regarding issues or concerns related to utilization, cost, quality, service and care delivery to patients.
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VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Fairview, New Jersey. Develops and maintains current knowledge of state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care, managed long term care as well as contractual requirements.
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Oversee population health management initiatives, including risk stratification, care coordination, and patient engagement strategies to improve health outcomes and reduce healthcare disparities.
Full-timeExpandApply NowActive JobUpdated 2 months ago - UpvoteDownvoteShare Job
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Ensures that the clinical management of the rehab department, including oversight related to case management, quality improvement, care planning, clinical utilization, and patient identification is overseen.
ExpandApply NowActive JobUpdated 6+ months ago
care utilization jobs in Hackensack, NJ
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