483 utilization jobs at 231 companies in Jackson, NJ
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Utilization Review
Marlboro Township, New Jersey, United States
OnsiteFull Time
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.
Nemours Children's Health: Pediatric health system providing clinical care, research, and education.
5+ YOEBSN and active DE RN license required, 5+ years related experience, conducts concurrent utilization reviews, ensures regulatory compliance and coordinates interdisciplinary care using EMR.
Diversified Treatment Alternative Centers: A provider of behavioral health services focused on quality care, compliance, and growth.
1+ YOEBachelor's degree in a related field, 1+ years utilization review/case management or behavioral health revenue cycle experience, strong understanding of medical necessity and authorization processes, attention to detail, and strong communication skills.
Conduct concurrent utilization reviews for psychiatric and residential drug/alcohol clients using ASAM criteria; coordinate appeals, maintain authorization and denial logs, and communicate with payers and treatment teams.
Malvern Health: Provides specialized inpatient and outpatient behavioral health treatment.
Master's degree or nursing graduate with Pennsylvania licensure; knowledge of ASAM and medical necessity criteria; utilization review experience preferred; Microsoft Office and billing experience; strong communication and documentation skills.
Manager Utilization Review - FT - Day - Utilization Resource Mgmt Trenton NJ
Trenton, New Jersey, United States
$98k-$128k/yrOnsiteFull Time
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.
WES Health System: Provides behavioral health and intellectual disability support services.
2+ YOEBachelor's in human services/care management, 2 years mental health or social services experience, familiarity with EHRs, proficient with Microsoft Office, strong communication and analytical skills.
EHR, Microsoft Excel, Microsoft Word, Microsoft PowerPoint
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.
Northbrook Behavioral Health Hospital: Provides inpatient psychiatric treatment and behavioral health services.
3+ YOEBachelor's degree, 3+ years inpatient behavioral health experience; knowledge of medical necessity criteria, concurrent review, payer authorization; strong clinical assessment, documentation, and communication skills.
Utilization Review Coordinator – Behavioral Health
Toms River, New Jersey, United States
OnsiteFull Time
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.
Jefferson: Providing healthcare services and academic programs in Pennsylvania.
2+ YOEMaster of Social Work and 2 years hospital social work experience required; performs psychosocial assessment, discharge planning, counseling, and multidisciplinary collaboration.
ChristianaCare: Provides hospital care and outpatient medical services.
3+ YOEDE or compact RN license, Bachelor’s in Nursing required, minimum 3 years acute care RN and 3 years utilization management, denial management and insurer experience, 8 CEUs/year in utilization/case management.
Hopewell or Newark or New Jersey or New York or Pennsylvania or Connecticut or Delaware
$71k-$94k/yrRemoteFull Time
Horizon Blue Cross Blue Shield of New Jersey: Provides health insurance and managed care products in New Jersey.
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
Registered Nurse - Utilization Management - Per Diem
Egg Harbor Township, New Jersey, United States
$45/hrOnsitePart Time, Temporary
AtlantiCare: Integrated healthcare system providing hospital and medical services.
BSN required, active NJ or multistate RN license, BLS required within 6 months, MCG certification required within 2 years, utilization/coding certification preferred; experience in utilization/insurance case management and familiarity with MCG/InterQual/HEDIS/CDI preferred.
MCG (Milliman Clinical Guidelines), InterQual, HEDIS, CDI, Microsoft Word, Microsoft Excel
ARRO Consulting: Engineering and environmental consulting firm providing municipal infrastructure services.
5+ YOEHigh school diploma, minimum 5 years operations or engineering experience, water/wastewater license preferred, ability to perform fieldwork and physical tasks.
Utilization Management Medical Director - Medical Oncology - Remote anywhere in US
Houston or Chicago or Atlanta or Phoenix or Los Angeles or Saint Louis or San Diego or Dallas or Philadelphia or Seattle
$249k-$373k/yrRemoteFull Time
UnitedHealth GroupNYSE: UNH: Provides health insurance and technology-enabled health care services.
5+ YOEMD or DO with current medical license; Board Certification in Oncology; 5+ years clinical experience in oncology; NCCN guideline experience; able to support utilization review and case/disease management.
Denver or Philadelphia or Redlands or Remote Eligible
$80k-$133k/yrRemoteFull Time
Esri: Developing software for digital mapping and spatial data analysis.
2+ YOE2+ years in utilities/telecommunications with ArcGIS; ArcGIS Utility Networks; GIS workflows; strong communication; Bachelor in geography or related field.
New York City or Milwaukee or Herndon or Dallas or Columbus or Kirkland or Irvine or Cincinnati or Cleveland or Oklahoma City or Austin or Albany or Chicago or Arlington or St. Petersburg or Hartford or Pittsburgh or St. Louis or Miami or Sacramento or Raleigh or Minneapolis or Mountain View or Scottsdale or Morristown or San Francisco or Denver or Boston or Philadelphia or Des Moines or Overland Park or Los Angeles or Charlotte or Walnut Creek or Carmel or Seattle or Houston or Arlington or Atlanta or Redmond or Bentonville or Beaverton or Nashville or Detroit or San Diego
$139k-$434k/yrHybridFull Time
AccentureNYSE: ACN: Global provider of management consulting and technology services.
10+ YOE10+ years in utility GIS solution architecture with full‑lifecycle ArcGIS Utility Network implementations; experience advising utility executives, defining enterprise GIS architecture, and leading large transformation programs; must be eligible to work in the US and willing to travel.