ⓘ There was an unexpected error processing your request.
Please refresh the page and try again.
If the problem persists, please contact us with your issue.
You can always manage your preferences and update your interests to ensure you receive the most relevant opportunities.
Get ready to discover your next great opportunity.
B.E. Smith
Newark, NJ, United States
Lead the Utilization and Case Management Department at University Hospital, a prestigious healthcare facility consistently recognized among the top hospitals in Northern New Jersey! The Position The Director of Utilization and Case Management will spearhead the strategic direction, management, continuous improvement, and overall maintenance of the
Job Source: B.E. SmithUniversity Hospital, Newark NJ
Newark, NJ, United States
Responsibilities: The Director Utilization and Case Management will be responsible for the strategic direction setting, management, continuous improvement, and maintenance of the Utilization and Case Management Services Unit. This role evaluates the efficiency, appropriateness, necessity of the use of medical services, procedures, and level of car
Job Source: University Hospital, Newark NJUnitedHealth Group
New York
Perform initial and concurrent review of inpatient cases applying evidenced-based criteria. Discuss cases with facility healthcare professionals to obtain plans-of-care. Collaborate with Optum Enterprise Clinical Services Medical Directors on perform..
Job Source: UnitedHealth GroupProgyny
New York, NY, United States
Thank you for considering Progyny! Progyny is looking for a Utilization Management Associate to join our team. This associate will be responsible for multiple administrative tasks to support the Utilization Management Clinical Coordinator and our Chief Medical Officer. The ideal candidate possesses strong attention to detail, excellent verbal, and
Job Source: ProgynyUnitedHealth Group
New York
Functional role is responsible for utilization management of LTSS determinations, oversight on outpatient service requests from a reporting perspective and understanding the criteria for inpatient reviews, including concurrent inpatient reviews.
Job Source: UnitedHealth GroupElevance Health
Brooklyn
**Utilization Management Representative III** **Location:** _Remote - the ideal candidate lives within 50 miles of a Pulse Point location._ The **Utilization Management Representative III** is responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + Responsible for providing technica
Job Source: Elevance HealthCVS Health
New York
Assess, plan, implement, and coordinate case management activities for members to evaluate their medical needs, reduce risk factors, and address complex health and social indicators in compliance with regulations and company policies.
Job Source: CVS HealthCVS Health
New York
Assess, plan, implement, coordinate, and evaluate healthcare services for members. Apply clinical criteria/guidelines and communicate with providers. Promote quality effectiveness of healthcare services and benefit utilization. Provide expertise in u..
Job Source: CVS HealthNewark, NJ, United States
Responsibilities:
The Director Utilization and Case Management will be responsible for the strategic direction setting, management, continuous improvement, and maintenance of the Utilization and Case Management Services Unit. This role evaluates the efficiency, appropriateness, necessity of the use of medical services, procedures, and level of care for patients. This position is empowered to review medical services with evidenced-based criteria that will be reviewed by payers. Develops and implements strategies to improve workflows and processes/procedures to enhance the utilization review program. Works to ensure care is delivered to patients at University Hospital in appropriate time frames to maximize patient flow and reimbursement. Ensures that discharge planning is thorough, patient-centered, and effective by fostering the concept of evidence-based practice and employing strategic interventions that assures that the care meets national, regional and University Hospital quality improvement standards. Provides decision support to patients, families, and physicians managing patient and family expectations. Supports the mission of University Hospital.
Qualifications:
Licensed as a Registered Nurse in the State of New Jersey. Bachelors Degree in Nursing required. Five (5) years of experience in an acute care setting, which must include at least two (2) years of experience in utilization review/case management/quality improvement leadership position required. Masters Degree is preferred. Excellent interpersonal, communication skills. Must demonstrate a strong orientation to customer satisfaction, effective teamwork, problem solving and utilize small group dynamics in conflict management. Computer literacy required. Must possess leadership and management ability.
#J-18808-Ljbffr
Director Utilization & Case Management jobs in Newark, NJ, United States
ⓘ There was an unexpected error processing your request.
Please refresh the page and try again.
If the problem persists, please contact us with your issue.
You can always manage your preferences and update your interests to ensure you receive the most relevant opportunities.
Get ready to discover your next great opportunity.