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872 utilization jobs at 356 companies in Edison, NJ

3d
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Utilization Review
Marlboro Township, New Jersey, United States
OnsiteFull Time
Discovery Institute of Addictive Disorders
Discovery Institute of Addictive Disorders: Provides professional drug and alcohol addiction treatment services.
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)
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2mo
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Director, Utilization Management
New York, New York, United States
$155k-$237k/yr OnsiteFull Time
Healthfirst
Healthfirst: Provides not-for-profit health insurance coverage to New York residents.
Senior-level leadership in utilization management with healthcare regulatory knowledge.
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3mo
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Utilization Management RN
Paterson, New Jersey, United States
OnsiteFull Time
St. Joseph's Health
St. Joseph's Health: Provides comprehensive hospital care and specialized clinical health services.
3+ YOEBSN required; 3+ years nursing experience; 3+ years utilization review/case management preferred; CCM certification preferred; NJ RN licensure required.
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1w
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Utilization Review Coordinator
Parsippany, New Jersey, United States
$33/hr OnsiteFull Time
Catholic Charities, Diocese of Paterson
Catholic Charities, Diocese of Paterson: Provides comprehensive social services to individuals and families.
2+ YOEBachelor's required (master's preferred), 2+ years behavioral health or utilization review experience, familiarity with insurance authorization and medical necessity, strong documentation and communication skills.
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2w
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Utilization Management Coordinator
Piscataway, New Jersey, United States
$71k-$101k/yr HybridFull Time
Rutgers University
Rutgers University: Providing higher education degrees and conducting academic research.
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.
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3mo
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Utilization Review Nurse (Medicare)
Spring Valley, New York, United States
$41-$47/hr OnsiteFull Time
Hamaspik Choice
Hamaspik Choice: Managed long-term care plan providing healthcare services to Medicaid-eligible individuals.
2+ YOERN with Medicare experience; 2+ years in utilization review; NY license; BSN preferred.
Medicare guidelines, N/A
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2mo
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Utilization Manager
Queens, New York, United States
$35-$38/hr OnsiteFull Time
Samaritan Daytop Village
Samaritan Daytop Village: A non-profit provider of behavioral health and supportive housing.
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.
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2mo
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Care Coordinator, Utilization Management
Edison, New Jersey, United States
$106k/yr OnsiteFull Time
Hackensack Meridian Health
Hackensack Meridian Health: Provides comprehensive medical care through a network of hospitals.
Coordinate care, review utilization, communicate with payors to manage patient progression.
Epic, Xsolis Cortex, Enterprise Analytics, Google Suites
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1mo
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RN Utilization Review Specialist
Nyack, New York, United States
$110k/yr OnsiteFull Time
Montefiore Nyack Hospital
Montefiore Nyack Hospital: A community acute care medical and surgical hospital.
4+ YOENY registered nurse required; performs utilization management, discharge planning, concurrent reviews using Interqual, documents medical necessity, coordinates care across team; 4-6 years clinical experience preferred.
Interqual, Care Management database, H/C PRI/Screen
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1w
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Manager Utilization Review - FT - Day - Utilization Resource Mgmt Trenton NJ
Trenton, New Jersey, United States
$98k-$128k/yr OnsiteFull Time
Capital Health
Capital Health: Provides comprehensive healthcare services through hospitals and medical clinics.
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.
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1mo
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Placement & Utilization Support Coordinator
New York, New York, United States
$41k-$45k/yr HybridFull Time
MJHS
MJHS: Provides home health, hospice, and long-term care services.
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
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2mo
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Senior Manager, Utilization Management
New York, New York, United States
OnsiteFull Time
1199SEIU Funds
1199SEIU Funds: Administers health, pension, and training benefits for union members.
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
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1mo
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Placement & Utilization Support Coordinator
New York, New York, United States
$41k-$45k/yr OnsiteFull Time
MJHS
MJHS: Provides hospice, home health, and skilled nursing care services.
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
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2mo
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Utilization Review Assistant
New York, New York, United States
$27-$34/yr OnsiteFull Time
Odyssey House
Odyssey House: Holistic substance use and mental health treatment services provider.
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
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3mo
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Utilization Review Specialist
Westchester, New York, United States
OnsiteFull Time
St. Vincent's Hospital Westchester
St. Vincent's Hospital Westchester: Provides psychiatric care and addiction recovery services.
1+ YOEOne year experience in Healthcare and/or Managed Care setting. Undergraduate/Bachelor Degree in Human or Health Services.
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2mo
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Utilization Review Analyst
Eagleville, Pennsylvania, United States
$50-$57/yr OnsiteFull Time
Eagleville Hospital
Eagleville Hospital: Specialty hospital providing addiction and mental health treatment services.
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
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5d
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Utilization Review RN Per Diem
New Brunswick, New Jersey, United States
$51/hr OnsitePart Time
Saint Peter's Healthcare System
Saint Peter's Healthcare System: Provides comprehensive acute care and specialized medical health services.
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.
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1w
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Utilization Review Coordinator – Behavioral Health
Toms River, New Jersey, United States
OnsiteFull Time
Avenues Recovery
Avenues Recovery: Provides comprehensive drug and alcohol rehabilitation services.
1+ YOEHigh school diploma (Bachelor's preferred), 1+ year behavioral health/treatment experience preferred, strong communication and documentation skills, CPR/First Aid and valid driver license, healthcare or nursing background preferred.
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6d
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Director of Utilization Management
New York City or New Jersey or Connecticut
$118k-$133k/yr HybridFull Time
VillageCare
VillageCare: Provides managed long-term care and community-based health services.
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.
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3w
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Utilization Management Specialist-MSH-Case Management-FT-Days
New York, New York, United States
$23-$34/hr OnsiteFull Time
Mount Sinai Health System
Mount Sinai Health System: Provides comprehensive hospital, clinical, and medical research services.
2+ YOEAssociates degree or equivalent (Bachelors preferred), 2+ years relevant experience, coordinating payer communications, denial management, data entry into tracking/EMR systems.
EMR
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