6d
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Utilization Review
Marlboro Township, New Jersey, United States
OnsiteFull Time
2+ YOE2+ years utilization review, case management, medical billing, or behavioral healthcare experience preferred; high school diploma required; knowledge of Medicaid, commercial insurance, ASAM criteria; strong communication and organizational skills.
Microsoft Office, Electronic Health Record (EHR)
2mo
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Director, Utilization Management
New York, New York, United States
$155k-$237k/yr OnsiteFull Time
Senior-level leadership in utilization management with healthcare regulatory knowledge.
3mo
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Utilization Management RN
Paterson, New Jersey, United States
OnsiteFull Time
3+ YOEBSN required; 3+ years nursing experience; 3+ years utilization review/case management preferred; CCM certification preferred; NJ RN licensure required.
1d
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Utilization Review Coordinator
Allentown, Pennsylvania, United States
$20/hr RemoteFull Time
3+ YOEAssociate degree required, 3+ years utilization review or related healthcare experience, intermediate Microsoft Office/Excel skills, knowledge of precertification/appeals and medical records.
Microsoft Excel, Microsoft Word, Microsoft Office
3w
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Utilization Management Coordinator
Piscataway, New Jersey, United States
$71k-$101k/yr HybridFull Time
3+ YOERequires RN license in New Jersey or Bachelor's in mental health, 3+ years mental health experience, utilization review and data entry skills preferred, ability to conduct reviews and communicate outcomes.
3mo
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Utilization Manager
Queens, New York, United States
$35-$38/hr OnsiteFull Time
1+ YOEHigh School Diploma or GED; CASAC or ability to obtain CASAC (T) within 6 months; 1+ year clinical or quality assurance experience; knowledge of HIPAA, OASAS, and 42 CFR; MS Office and EHR proficiency; ability to work with diverse populations; strong communication skills; bilingual Spanish a plus.
3mo
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Utilization Review Nurse (Medicare)
Spring Valley, New York, United States
$41-$47/hr OnsiteFull Time
2+ YOERN with Medicare experience; 2+ years in utilization review; NY license; BSN preferred.
Medicare guidelines, N/A
2mo
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Care Coordinator, Utilization Management
Edison, New Jersey, United States
$106k/yr OnsiteFull Time
Coordinate care, review utilization, communicate with payors to manage patient progression.
Epic, Xsolis Cortex, Enterprise Analytics, Google Suites
2w
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Manager Utilization Review - FT - Day - Utilization Resource Mgmt Trenton NJ
Trenton, New Jersey, United States
$98k-$128k/yr OnsiteFull Time
4+ YOEBSN required (ADN with additional experience may be considered), active NJ RN, BLS recommended, 4+ years nursing experience with utilization review/case management, strong analytical and leadership skills.
2mo
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Senior Manager, Utilization Management
New York, New York, United States
OnsiteFull Time
6+ YOE3+ MgmtBachelor's degree plus RN license; 6+ years in Utilization/Case Management/Appeals within managed care; 3+ years of leadership; Milliman guidelines knowledge; strong decision-making, communication, and MS Office skills.
Microsoft Office
1mo
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Placement & Utilization Support Coordinator
New York, New York, United States
$41k-$45k/yr HybridFull Time
1+ YOE1 year customer service experience required; healthcare experience preferred. Familiarity with utilization/case management, HealthRules Payor, Microsoft Word and Excel, 55 wpm typing, and strong customer service and interdisciplinary teamwork skills.
HealthRules Payor, Microsoft Word, Microsoft Excel
1mo
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Placement & Utilization Support Coordinator
New York, New York, United States
$41k-$45k/yr OnsiteFull Time
1+ YOE1 year customer service experience required; healthcare experience preferred. Familiarity with utilization/case management, HealthRules Payor, Microsoft Word and Excel; typing 55 wpm; strong customer service and interdisciplinary teamwork skills.
HealthRules Payor, Microsoft Word, Microsoft Excel
3mo
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Utilization Review Analyst
Eagleville, Pennsylvania, United States
$50-$57/yr OnsiteFull Time
3+ YOE3+ years UR or case management experience in Substance Use / Behavioral Health; good communication; ability to work independently; MS Office experience; knowledge of pre-certification, DSM V, private care managers, and county referrals.
Microsoft Office
2mo
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Utilization Review Assistant
New York, New York, United States
$27-$34/yr OnsiteFull Time
3+ YOEAdministrative support in healthcare; HS diploma or GED with 3 years experience or associate degree; strong organization; proficient in MS Office and EHR; excellent communication.
Microsoft Word, Excel, Electronic Health Records, Outlook
1w
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Utilization Review RN Per Diem
New Brunswick, New Jersey, United States
$51/hr OnsitePart Time
3+ YOEActive New Jersey RN license, 3+ years acute care nursing experience, ability to assess clinical records for medical necessity, strong communication and computer skills.
1w
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Director of Utilization Management
New York City or New Jersey or Connecticut
$118k-$133k/yr HybridFull Time
3+ YOE5+ MgmtMinimum 5 years management in health-related field, 3 years quality management, Bachelor's required (Master's preferred), active NYS RN license or willing to obtain within 3 months, experience analyzing data and knowledge of Medicare/Medicaid quality regulations.
3w
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Utilization Management Specialist-MSH-Case Management-FT-Days
New York, New York, United States
$23-$34/hr OnsiteFull Time
2+ YOEAssociates degree or equivalent (Bachelors preferred), 2+ years relevant experience, coordinating payer communications, denial management, data entry into tracking/EMR systems.
EMR
3w
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Utilization Management Specialist-MSH-Case Management-FT-Days
New York, New York, United States
$23-$34/hr OnsiteFull Time
2+ YOEAssociates degree or equivalent (Bachelors preferred), 2+ years relevant experience, experience with EMR and data entry, payer authorization and denial management skills, strong communication.
Microsoft Office Suite, EMR
2w
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OP Enforcement Manager
New York or New York
$160k-$170k/yr OnsiteFull Time
7+ YOEBachelor's in electrical or power system engineering,7+ years utility experience in planning or operations,PE or NERC operator cert preferred,ability to assess risk and communicate technical findings.
Microsoft Office
1w
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RN I- Utilization Management
Hopewell or Newark or New Jersey or New York or Pennsylvania or Connecticut or Delaware
$71k-$94k/yr RemoteFull Time
2+ YOEAssociate/bachelor/diploma in nursing, active unrestricted NJ RN license, minimum 2 years clinical experience, knowledge of utilization/case management, proficiency with MS Office and Windows, strong analytical and communication skills.
Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Outlook, Windows, intranet, internet