Utilization review nurse jobs in Plainfield, NJ - 422 jobs

Requisition ID JR1004947 Category Managed Care Type Regular Full-Time AmTrust Financial Services, a fast-growing commercial insurance company, has a need for Clinical Review Nurse remote or in an office location. PRIMARY PURPOSE: The Clinical Review nurse has the responsibility of reviewing the medical necessity, appropriateness, quality and efficiency of services in the appropriate setting for Workers' Compensation claimants. This position assesses the medical appropriateness of proposed treatments and medications for our injured employees, and partners with the AmTrust Claims Adjuster team to expedite medically necessary treatment for each claim. They also review pharmacy authorizations to determine appropriateness of pharmaceutical treatment. Maintains a solid understanding of AmTrust's mission, vision, and values. Upholds the standards of the AmTrust organization. This position will be hybrid out of one of our AmTrust office locations! Responsibilities Perform Utilization Review activities prospectively, concurrently, or retrospectively in accordance with the appropriate jurisdictional guidelines. Uses clinical/nursing skills to determine whether all aspects of a patient's care, at every level, are medically necessary and appropriately delivered. Responsible for helping to ensure injured employees receive appropriate level and intensity of care directly related to the compensable injury using industry standard and/or state specific medical treatment guidelines and formularies. Objectively and critically assesses all information related to the current treatment request to make the appropriate medical necessity determination. Sends determination letters as needed to requesting physician(s) and refers to physician advisors for second level reviews as necessary. Responsible for accurate comprehensive documentation of Utilization Review activities in the case management and pharmacy benefit management systems. Responsible for completing timely reviews according to state's requirements and communicating the UR determination to all parties. Uses clinical/nursing skills to help coordinate the individual's treatment program while maximizing quality and cost-effectiveness of care. Communicates effectively with providers, claims adjuster, client, and other parties as needed to expedite appropriate medical care Keeps current with market trends and demands. Performs other functionally related duties as assigned Qualifications Active unrestricted RN license in a state or territory of the United States with eligibility to get and/or renew a multistate license. 5+ years of related experience or equivalent combination of education and experience required to include 2+ years of direct clinical care OR2+ years of utilization management required. Education & Licensing Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred. Acquisition and maintenance of Insurance License(s) may be required to comply with state requirements. Preferred for license(s) to be obtained within three - six months of starting the job. Skills & Knowledge Proficiency in all Microsoft Office products including Project, Word, Excel, PowerPoint, Visio, and SharePoint Knowledge of workers' compensation laws and regulations, behavioral health, case management practice, URAC standards, ODG, Utilization review, pharmaceuticals to treat pain, pain management process, drug rehabilitation, state workers compensation guidelines, periods of disability, and treatment needed Excellent oral and written communication, including presentation skills Ability to interact collaboratively and work effectively with a multi-functional team and throughout the organization; fosters an environment of shared responsibility and accountability Strong organizational, communication and analytical skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding Auditory/Visual: Hearing, vision and talking The expected salary range for this role is $53,300-$92,500. Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. #LI-GH1 #LI-HYBRID #AmTrust What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future. Connect With Us! Not ready to apply? Connect with us for general consideration.

RN Case Manager / Utilization Review (Inpatient) Shift: Days, Monday-Friday 8:00 AM-4:00 PM; every other Saturday required (8:00 AM-4:00 PM) Guaranteed Hours: 40/week Contract Length: ~13 weeks Position Summary: RN Case Manager responsible for coordinating inpatient care, utilization management, and discharge planning. The role focuses on concurrent review, high-risk patient identification, collaboration with physicians and interdisciplinary teams, and communication with third-party payers to ensure appropriate level of care and timely discharge. Key Responsibilities: Perform concurrent utilization and continued-stay reviews Identify high-risk patients and develop discharge plans for uncomplicated cases Coordinate with physicians to establish and update time-oriented plans of care Communicate clinical information to third-party payers and complete retro reviews Monitor delays, duplication of services, and appropriateness of care Collaborate with social work and interdisciplinary teams to facilitate discharge Ensure accurate documentation and participation in quality and performance improvement activities Requirements: Active New York State RN license BSN required Minimum 3 years of direct patient care experience BLS and ACLS required Strong utilization review, discharge planning, and interdisciplinary collaboration skills Preferred: MSN CCM (Certified Case Manager) PALS Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts. Best Regards, Tabish Ahmad

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Case Manager RN, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. If you are located within Essex County, New Jersey, territory and willing to travel up to 80% of your time to assigned territory, you will have the flexibility to work remotely as you take on some tough challenges Primary Responsibilities: Comprehensive Assessment & Care Planning Conduct thorough health assessments, including medical history, chronic conditions, behavioral health, and social determinants of health Develop individualized care plans that address medical, rehabilitation, behavioral health, and social needs Create personalized interventions that integrate medical treatment, support services, and community resources Member Engagement, Education & Self-Management Build and maintain relationships with an established caseload of high-risk members Provide education to members and caregivers on disease processes, treatment adherence, and lifestyle changes Encourage self-management strategies that support long-term wellness and reduce complications Maintain consistent outreach to support adherence to care plans and monitor evolving needs Intensive Care Coordination Coordinate services across providers, including PCPs, specialists, hospitals, LTSS, behavioral health, and pharmacy. Facilitate referrals for home health, hospice, palliative care, and DME Collaborate with Medical Directors during interdisciplinary rounds to review and align care for complex cases Discharge Planning & Transitional Care Support members through transitions of care such as hospitalization, skilled nursing, and rehabilitation Conduct "welcome home" and follow-up calls to ensure post-discharge services, medications, and follow-up appointments are in place Deliver intensive outreach during the 30-day post-discharge period to reduce avoidable readmissions and ED utilization Advocate for safe, coordinated, and timely transitions of care that align with the member's individualized care plan Field-Based Care Management (20% of Time) Conduct home and hospital visits in North Jersey as required by program guidelines Perform in-person assessments and provide care coordination to address high-risk needs and ensure continuity of care Collaborate directly with providers, facilities, and families during field visits to close care gaps and reinforce the care plan Monitoring & Clinical Oversight Monitor members' clinical conditions, care plan progress, and treatment adherence Reassess care plans regularly and adjust interventions based on changing needs or barriers Identify red-flag conditions and escalate urgent or complex cases for higher-level review and intervention Documentation, Compliance & Quality Outcomes Document all assessments, care plans, interventions, and communications per NCQA, CMS, and state regulatory requirements Ensure care management services align with DSNP/NCQA standards and contract requirements Track outcomes tied to quality metrics (HEDIS, STARs), utilization management, and member satisfaction Maintain audit readiness through timely, accurate, and comprehensive documentation You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted RN license in New Jersey 2+ years of Case Management Experience serving complex, elderly and disabled Experience with government health programs (Medicaid/Medicare) Proficient in Microsoft Office Suite; tech-savvy with ability to navigate multiple systems simultaneously Demonstrated ability to talk and type proficiently at the same time Access to reliable transportation and the ability to travel up to 80% within assigned territory. Available for occasional in-person meetings as needed Preferred Qualifications: Certified Case Manager (CCM) Experience working with populations with special needs (DSNP) Experience with Managed Care Population Bilingual - English/Spanish Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $40.00 to $54.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Schedule: 9:30am-6:00pm local time, with rotating weekends. New Grads are encouraged to apply! The Nurse Reviewer I will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. * Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. * Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. * Partners with more senior colleagues to complete non-routine reviews. * Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: * Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. * Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. * Notifies ordering physician or rendering service provider office of the preauthorization determination decision. * Follows-up to obtain additional clinical information. * Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: * AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. * Knowledge in Microsoft office. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $33.12/hr - $56.77/hr Locations: New York, New Jersey, Washington, Nevada, Maryland, Massachusetts, Illinois, District of Columbia In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Non-Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

One of the largest health benefits companies in the United States. Through its networks nationwide, the company delivers a number of leading health benefit solutions through a broad portfolio of integrated health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts. Headquartered in Indianapolis, Indiana, WellPoint, Inc. is an independent licensee of the Blue Cross and Blue Shield Association serving members in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin; and specialty plan members in other states through UniCare. Job Description This role is specific to the LTSS department. RN will be responsible for providing case management services and evaluating the necessity/appropriateness/efficiency of the use of Medical Services for Long-Term Support Services (LTSS). Will be responsible for collaborating with providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. May also manage appeals for services denied. Provides plan of care for members based on authorization and concurrent review. Provides monthly telephonic outreach to ensure members needs are assessed and met based on information. Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. MAJOR JOB DUTIES AND RESPONSIBILITIES Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs, or community resources. Applies clinical knowledge to work with facilities and providers for care coordination. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract. Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process. Collaborates with providers to assess member's needs for early identification of and proactive planning for discharge planning. Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications. Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards. Additional Info: *possible remote opportunity after training if candidate demonstrates understanding of processes and policy expectations* Qualifications Must have clear and active RN license in the state of NY Requires an AS/BS in Nursing At least 2 years of acute care clinical experience; or any combination of EDU/experience that would provide an equivalent background Excellent written and verbal communication skills Additional Information Advantages of this Opportunity: Competitive salary, negotiable based on relevant experience Benefits offered, Medical, Dental, and Vision Fun and positive work environment Monday through Friday 8am-5pm

The Utilization Management Nurse will conduct reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination in accordance with Utilization Management policies and procedures. ESSENTIAL FUNCTIONS Perform utilization management, utilization review, or concurrent review (on-site at a hospital, or telephonic inpatient care management) of hospitalized members ensuring medical necessity, appropriateness of admission, and continued stay following evaluation of medical and benefit determination guidelines. Maintains compliance with all state mandated regulations. Collaboration with hospital staff, physicians, care/service coordinators, plan Medical Director, members and their families to provide the level of care necessary to meet member's health needs. Maintain an active role in assuring the continuity of care for all inpatients through early discharge planning and working with hospital discharge planners and health plan social workers or other staff in the early identification of potential home care candidates or less restrictive level of care placement. Identification and management of members at high risk for readmission or with complex medical and psychosocial needs. Collaboration with Case Manager to coordinate post discharge care and services aimed at: increasing rates of timely outpatient follow-up, ensuring provider treatment plan, medications & outpatient services are in place, safe transition to outpatient setting, improving self management skills, addressing members psychosocial and non-medical needs Communicate directly with physician providers/designees when appropriate to gather all clinical information to determine the medical necessity of requested healthcare services. Maintains courteous, professional attitude when working with Affinity staff, hospital and physician providers, and members. Collect pertinent clinical information and documents all UM review information using the appropriate software system. Manage medical / benefits resources effectively and efficiently while ensuring quality care is provided as determined by guidelines of meeting Medical necessity. Communicate directly with appropriate internal staff regarding all inpatient cases and outpatient/ambulatory requests for health care services that do not meet medical necessity or appropriate level of care and out of network transfer issues. Manage assigned workload within established performance standards. Follow relevant client time frame standards for conducting and communicating UM review determination. Maintain and submit reports and logs on review activities as outlined by the UM program operational procedures. Contribute to MM program goals and objectives in containing health care costs and maintaining a high quality medical delivery system through the program procedures for conducting UM activities. Participate in a multi-disciplinary team approach to address member needs from the acute care phase through the post-acute care phase. Identify and coordinate quality of care issues or trends with the Quality Management department. Demonstrate proficiency with the principles and methodologies of process improvement. Apply these in the execution of responsibilities in support of a process focused approach. Perform other duties as necessary or assigned. QUALIFICATIONS: Registered Nurse or Licensed Practical Nurse with current, unrestricted, licensure required for state of New York Associates degree in Nursing required; BSN preferred 3+ years Clinical experience and 2 or more years experience working in utilization management required Experience working in Medicaid and/or Medicare managed care, including regulatory and compliance requirements strongly preferred Experience with MCG guidelines preferred Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint and Outlook required Ability to work with minimal guidance; seeks guidance on only the most complex tasks Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others. Advanced interpersonal (e.g., mediating, counseling, mentoring, influencing), negotiating and management skills required to manage critical internal and external relationships and activities that are diverse and complex. Ability to collaborate constructively with others within and outside the organization. Ability to work resourcefully and creatively, to think independently, and to exercise sound judgment in a complex and dynamic environment. Commitment to the corporate mission, vision, and values. High level of integrity as demonstrated by a) appropriate treatment of confidential information, b) adherence to policies, procedures, rules and regulations, c) professional conduct in dealing with persons internal and external to the organization, and d) sensitivity to the populations served by Affinity and the providers with which Affinity works.

Clinical Document-Coding Mgmt Saint Peter's is among the few hospitals in the world to have earned its 7th consecutive Magnet designation and its first Magnet with Distinction designation. The Magnet with Distinction designation is an elite level of this recognition, awarded to organizations that demonstrate exceptional performance in nursing practices and patient outcomes. Our team of award-winning nurses is growing, and we are looking for talented, compassionate RNs to join our team. The Utilization Review RN Per Diem will: * Identify appropriate medical information necessary to certify and/or refer cases on admission and on continued stay reviews. * The review of the medical record includes all pertinent information required by insurance payers including the reason for admission, current symptoms, abnormal lab values, abnormal diagnostics, outpatient condition prior to an admission and response or lack of response to such treatment. Review medication administration record to identify antibiotics administered, dose and frequency, respiratory treatments, medical/surgical and social history. Documentation if discharged from a hospital within 30 days, as well as any pertinent clinical information. * Performs assigned admission reviews within established time frame in accordance with payer requirements as well as daily reviews for Medicare, Medicaid and managed care companies per their requirements. * Ensures timely provision of clinical review information to payer as evidenced by no denials for lack of clinical information. Collaborates with patient registration /resource services for issues related to insurance coverage (i.e., correct insurance is not in patient record. * Whenever possible, manages requests for concurrent reconsiderations as evidenced by the "overturn" of the initial denial decision. * Initiates collaboration with the Medical Staff or Clinical Documentation Specialists by identifying additional clinical information required for obtaining payer determination for approval of the admission. * Identifies hospital stays at risk for admission downgrades or denials and involves the Physician Advisor in a timely fashion when assistance is needed. * Refers cases to the Physician Advisor when a change in level of care or termination of benefits seems applicable based upon criteria for Medicare/Medicaid patients (i.e., certification of acute days versus custodial or SNF). * Utilizes case management software including utilization criteria guidelines, to capture essential admission clinical review documentation. Requirements: * Registered nurse currently licensed to practice in the State of New Jersey. * Required to have three (3) to five (5) years-nursing experience working in an acute care hospital setting, preferably medical/surgical or critical care. * Experience should include assessment of a patient's diagnosis, prognosis, care needs responsible for a patient admission. * The ability to clinically assess the patient condition for establishing medical necessity justifying an inpatient admission by analyzing medical records, interpreting clinical and laboratory data. * Must have excellent interpersonal, communication, organizational and computer skills. * Flexible and able to work independently and part of a team. Salary Range: 51.00 - 51.00 USD We offer competitive base rates that are determined by many factors, including job-related work experience, internal equity, and industry-specific market data. In addition to base salary, some positions may be eligible for clinical certification pay and shift differentials. The salary range listed for exempt positions reflects full-time compensation and will be prorated based on employment status. Saint Peter's offers a robust benefits program to eligible employees that will support you and your family in working toward achieving and maintaining secure, healthy lives now and into the future. Benefits include medical, dental, and vision insurance; savings accounts, voluntary benefits, wellness programs and discounts, paid life insurance, generous 401(k) match, adoption assistance, back-up daycare, free onsite parking, and recognition rewards. You can take your career to the next level by participating in either a fully paid tuition program or our generous tuition assistance program. Learn more about our benefits by visiting our site at Saint Peter's.

Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST. * This position will service members in different states; therefore, Multi-State Licensure will be required. This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. * Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state required. * Multi-state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences: * Case Management experience. * Certification as a Case Manager. * Minimum 2 years' experience in acute care setting. * Managed Care experience. * Ability to talk and type at the same time. * Demonstrate critical thinking skills when interacting with members. * Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly. * Ability to manage, review and respond to emails/instant messages in a timely fashion. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $76,944 to $126.408. Locations: Colorado; New York; New Jersey In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

**his position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management.** **Responsibilities:** 1. Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay. 2. Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided. 3. Coordinates and assists in implementation of plan for members. 4. Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate. Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome. 5. Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care. 6. Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness. 7. Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. 8. Encourages member participation and compliance in the case/disease management program efforts. 9. Documents accurately and comprehensively based on the standards of practice and current organization policies. 10. Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care. 11. Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes. 12. Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes. 13. Completes other assigned functions as requested by management. Core Individual Contributor Competencies. Personal and professional attributes that are critical to successful performance for Individual Contributors: Customer Focus, Accountable, Learn, Communicate. **Qualifications:** **Education/Experience** 1. Requires an associate's or bachelor's degree (or higher) in nursing and/or a health related field OR accredited diploma nursing school. 2. Requires a minimum of two (2) years clinical experience. **Additional licensing, certifications, registrations:** 1. Requires an active New Jersey Registered Nurse License. **Knowledge:** - Prefers proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; prefers knowledge in the use of intranet and internet applications. - Prefers working knowledge of case/care management principles. - Prefers working knowledge of principles of utilization management. - Prefers basic knowledge of health care contracts and benefit eligibility requirements. - Prefers knowledge of hospital structures and payment systems. **Skills and Abilities:** - Analytical - Compassion - Interpersonal & Client Relationship Skills - Judgment - Listening - Planning/Priority Setting - Problem Solving - Team Player - Time Management - Written/Oral Communication & Organizational Skills **About US Tech Solutions:** US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit *********************** (********************************** . US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job DescriptionDescription: Tillman FiberCo is building a network with future-forward technologies, systems and network architecture that will be ultimately capable of delivering 40Gbps+ to customers. Tillman FiberCo is a portfolio company of Tillman Global Holdings, a holding company focused on building premier digital infrastructure businesses globally. We have an incredible opportunity for a Utility Coordinator to support the work in Hernando, Citrus, Sumter, Marion, Volusia, Seminole, Brevard, Palm Beach, Broward and Miami-Dade Counties. Ideal candidate location would be based in Osceola, St. Lucie, or Indian River County. Responsibilities: Oversee relations between our vendor and the jurisdictions as well as manage the quality and direction requested by the jurisdiction and intervene when necessary to ensure that permit requirements are being fulfilled. Only if it's an electrical permit. Ensure all permit payments are timely and invoiced appropriately and Audit and Maintain SFU/MDU OSP permits and ROW payment records in Sitetracker. Power company/construction invoices. Work with our vendor partners in getting utility accounts set up with power companies Review Utility and permit Work Plans and recommend for approval. Pertains to vetting the locations. As necessary, interfaces with jurisdictional staff to ensure compliance with applicable laws, codes, and ordinances, and leverage regulatory status to support deployment objectives. Tracks project progress and maintain accurate data entry. Communicate with the electrician. Acts as a point of contact for internal and external customers regarding specific power companies. Ensures all permits are submitted in a timely manner to ensure fiber build projects are not delayed. Additional Responsibilities: Identifying and resolving conflicts between existing utilities and proposed construction designs. Field verification of proposed location and existing utilities. Travel to locations will be expected. Create utilities project work orders with all utility companies involved in projects. Communicate with engineers to ensure smooth interactions and project development. Collaborating with utility companies, project designers, and other stakeholders to ensure smooth coordination. Develop working relationships with engineers and customer service. Maintaining accurate records of utility locations, drawings, and documentation. Include design and permit prints, verify for accuracy. Trackers that include utilities milestones (permits for electrical, gas, water, etc.) submittal and approval dates. Managing the relocation of utilities, including obtaining necessary permits and ensuring compliance with regulations. Providing support to design teams by attending meetings, reviewing documents, and facilitating site visits. Tracking the progress of relocation efforts and ensuring timely completion. Communicate with municipality personnel to identify projects that may affect project construction progress. Assisting with the preparation of contingency plans for unplanned utility events. Identifying and locating utilities within project boundaries using various methods and technologies. Preparing and reviewing utility agreements with utility companies. Obtaining necessary permits for utility relocation and construction. Providing schedule oversight for utility work integrated with the overall construction schedule. Conducting utility coordination meetings and documenting meeting minutes. Communicate with customer service to initiate service accounts. In some instances, travel to the proposed construction locations is expected. Maintain a good driving record. Maintain service on company vehicle up to date. Requirements: What we are looking for Location: Must reside within the service area spanning the counties listed and be willing to travel regularly throughout these locations . Candidates outside the area will be considered only if able to relocate or travel frequently within the region. Experience: High school diploma or GED required. Minimum 2+ years of utility coordination experience with power companies (e.g., TECO, Duke Energy, FPL, KUA). Hands-on fielding experience strongly preferred, including: Vetting proposed cabinet locations Verifying transformer proximity Assessing site conditions (e.g., flood zones) Experience with and understanding of wireline technologies for OSP fiber builds (buried, aerial, underground). Knowledge of National Electrical Safety Code (NESC), Rural Utilities Service (RUS) codes, and relevant building codes is a plus. Technical Skills: Proficient in Microsoft Office and Adobe Acrobat. Working knowledge of Excel and Google Earth/Maps. Salesforce Sitetracker experience preferred. Key Competencies: Highly organized, self-starter with excellent time management and attention to detail. Strong written, verbal, and interpersonal communication skills, including negotiation, consensus building, and problem-solving. Ability to take direction, adapt to changing priorities, and work independently or collaboratively. Critical thinking skills to assess challenges, anticipate conflicts, and develop solutions. Additional Requirements: Valid driver's license with a clean MVR (Motor Vehicle Record). Ability to work 50% in the field (site vetting, coordination with engineers and power companies, attending meter set appointments) and 50% from home (updating SiteTracker, managing invoices/accounts, maintaining trackers, coordinating with internal teams). Willingness to travel within assigned geographic area. Successful completion of MVR check. As a growing company, we are committed to attracting and developing the absolute best talent by offering a workplace where results are recognized and rewarded. We offer a terrific opportunity for you to grow: Challenging, rewarding career within a growing company, backed by a global investor and owner of digital infrastructure assets. Competitive Salary East Coast based company (will work on EST time) Direct Hire Opportunity Collaborative environment, with on-the-job training and mentorship opportunities Competitive benefits and wellness package, including medical, dental and vision coverage. 401k plan with company match Generous PTO and 11 holidays annually Paid parental leave. Employee Recognition Program

Leading social service organization seeks a Nurse Case Manager (RN) to oversee comprehensive nursing care for individuals with developmental disabilities in a residential setting. The Nurse Case Manager also supervises and trains nursing and direct support staff while coordinating all ongoing and acute healthcare needs. Key Responsibilities Provide and oversee direct nursing care in accordance with physician/Nurse Practitioner orders and regulatory standards Conduct regular nursing assessments and ongoing health monitoring for residents Develop, implement, and update individualized nursing care plans Coordinate and manage all medical services, appointments, and treatments Monitor labs, medications, and treatment effectiveness; communicate changes to clinical teams Maintain accurate, timely, and compliant medical documentation in electronic health records Supervise and support LPNs, AMAPs, and Direct Support Professionals Train staff on medication administration, health and hygiene, infection control, seizure management, and other medical needs Ensure new hires are properly trained prior to independent client care Conduct annual clinical competency evaluations for unlicensed staff Participate in interdisciplinary team (IDT) meetings and quality improvement initiatives Promote a patient-centered, respectful, and safe care environment Qualifications Licensed Registered Nurse Minimum of 3 years of clinical nursing experience Experience working with individuals with intellectual or developmental disabilities preferred Schedule: Monday - Friday, 9AM - 5PM (No Weekends or Holidays) Salary: $100,000 - $110,000 Please email resume to: Joshua Albucker Senior Vice President NOOR Staffing Group 646-492-5653 jalbucker@noorstaffing.com

1. Graduate from an accredited School of Nursing, (BSN preferred) 2. Two years of Oncology, Home Care, ER or Critical Care nursing experience required 3. New York State RN licensure 4. Valid NYS Driver's license required 5. 1 year of Case Management experience preferred Job description: The Hospice Field Case Manager is a field based, full time position. You will visit Hospice and Palliative Care patients to perform both physical and psycho-social assessments and electronically document visit occurrences. Patient visits will be made in both community and facility settings. In addition, you will also supervise, train and evaluate home health aides and homemakers working with our hospice patients. **They need candidates who can speak both English and Russian** Plus

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today! If you are located within Northern New Jersey territory and willing to travel up to 20% of your time to assigned territory, you will have the flexibility to work remotely as you take on some tough challenges. Primary Responsibilities: Comprehensive Assessment & Care Planning Conduct thorough health assessments, including medical history, chronic conditions, behavioral health, and social determinants of health Develop individualized care plans that address medical, rehabilitation, behavioral health, and social needs Create personalized interventions that integrate medical treatment, support services, and community resources Member Engagement, Education & Self-Management Build and maintain relationships with an established caseload of high-risk members Provide education to members and caregivers on disease processes, treatment adherence, and lifestyle changes Encourage self-management strategies that support long-term wellness and reduce complications Maintain consistent outreach to support adherence to care plans and monitor evolving needs Intensive Care Coordination Coordinate services across providers, including PCPs, specialists, hospitals, LTSS, behavioral health, and pharmacy. Facilitate referrals for home health, hospice, palliative care, and DME Collaborate with Medical Directors during interdisciplinary rounds to review and align care for complex cases Discharge Planning & Transitional Care Support members through transitions of care such as hospitalization, skilled nursing, and rehabilitation Conduct "welcome home" and follow-up calls to ensure post-discharge services, medications, and follow-up appointments are in place Deliver intensive outreach during the 30-day post-discharge period to reduce avoidable readmissions and ED utilization Advocate for safe, coordinated, and timely transitions of care that align with the member's individualized care plan Field-Based Care Management (20% of Time) Conduct home and hospital visits in North Jersey as required by program guidelines Perform in-person assessments and provide care coordination to address high-risk needs and ensure continuity of care Collaborate directly with providers, facilities, and families during field visits to close care gaps and reinforce the care plan Monitoring & Clinical Oversight Monitor members' clinical conditions, care plan progress, and treatment adherence Reassess care plans regularly and adjust interventions based on changing needs or barriers Identify red-flag conditions and escalate urgent or complex cases for higher-level review and intervention Documentation, Compliance & Quality Outcomes Document all assessments, care plans, interventions, and communications per NCQA, CMS, and state regulatory requirements Ensure care management services align with DSNP/NCQA standards and contract requirements Track outcomes tied to quality metrics (HEDIS, STARs), utilization management, and member satisfaction Maintain audit readiness through timely, accurate, and comprehensive documentation You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted RN license in New Jersey 2+ years of Case Management Experience serving complex, elderly and disabled Experience with government health programs (Medicaid/Medicare) Proficient in Microsoft Office Suite; tech-savvy with ability to navigate multiple systems simultaneously Demonstrated ability to talk and type proficiently at the same time Access to reliable transportation and the ability to travel up to 20% within assigned territory. Available for occasional in-person meetings as needed Preferred Qualifications: Certified Case Manager (CCM) Experience working with populations with special needs (DSNP) Experience with Managed Care Population Bilingual - English/Spanish *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Schedule: 9:30am-6:00pm local time, with rotating weekends. New Grads are encouraged to apply! The Nurse Reviewer I will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. * Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. * Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. * Partners with more senior colleagues to complete non-routine reviews. * Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: * Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. * Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. * Notifies ordering physician or rendering service provider office of the preauthorization determination decision. * Follows-up to obtain additional clinical information. * Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: * AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. * Knowledge in Microsoft office. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $33.12/hr - $56.77/hr Locations: New York, New Jersey, Washington, Nevada, Maryland, Massachusetts, Illinois, District of Columbia In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Non-Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care. Key Responsibilities Conduct prospective, concurrent, and retrospective drug utilization reviews. Evaluate prescribing patterns against clinical guidelines and formulary criteria. Identify potential drug interactions, duplications, and inappropriate therapy. Prepare recommendations for prescribers to optimize therapy and reduce risk. Document reviews and ensure compliance with state, federal, and health plan requirements. Contribute to quality improvement initiatives and pharmacy program development. What You'll Bring Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree. Licensure: Active and unrestricted pharmacist license in the U.S. Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply. Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication. Why This Role? Impact: Shape prescribing decisions that affect thousands of patients. Growth: Build expertise in managed care and population health pharmacy. Flexibility: Many DUR roles offer hybrid or fully remote schedules. Rewards: Competitive salary, benefits, and career advancement opportunities. About Us We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations. Apply Today Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.

Job Description Leading social service organization seeks a Nurse Case Manager (RN) to oversee comprehensive nursing care for individuals with developmental disabilities in a residential setting. The Nurse Case Manager also supervises and trains nursing and direct support staff while coordinating all ongoing and acute healthcare needs. Key Responsibilities Provide and oversee direct nursing care in accordance with physician/Nurse Practitioner orders and regulatory standards Conduct regular nursing assessments and ongoing health monitoring for residents Develop, implement, and update individualized nursing care plans Coordinate and manage all medical services, appointments, and treatments Monitor labs, medications, and treatment effectiveness; communicate changes to clinical teams Maintain accurate, timely, and compliant medical documentation in electronic health records Supervise and support LPNs, AMAPs, and Direct Support Professionals Train staff on medication administration, health and hygiene, infection control, seizure management, and other medical needs Ensure new hires are properly trained prior to independent client care Conduct annual clinical competency evaluations for unlicensed staff Participate in interdisciplinary team (IDT) meetings and quality improvement initiatives Promote a patient-centered, respectful, and safe care environment Qualifications Licensed Registered Nurse Minimum of 3 years of clinical nursing experience Experience working with individuals with intellectual or developmental disabilities preferred Schedule: Monday - Friday, 9AM - 5PM (No Weekends or Holidays) Salary: $100,000 - $110,000 Please email resume to: Joshua Albucker Senior Vice President NOOR Staffing Group 646-492-5653 jalbucker@noorstaffing.com

**Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. _Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law._ **Schedule:** **9:30am-6:00pm local time,** **with rotating weekends.** **New Grads are encouraged to apply!** The **Nurse Reviewer I** will be responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. + Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. + Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. + Partners with more senior colleagues to complete non-routine reviews. + Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. **How you will make an impact:** + Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. + Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. + Notifies ordering physician or rendering service provider office of the preauthorization determination decision. + Follows-up to obtain additional clinical information. + Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics. **Minimum Requirements:** + AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. + Current unrestricted RN license in applicable state(s) required. **Preferred Skills, Capabilities, and Experiences :** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred. + BA/BS degree preferred. + Previous utilization and/or quality management and/or call center experience preferred. + Knowledge in Microsoft office. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $33.12/hr - $56.77/hr Locations: New York, New Jersey, Washington, Nevada, Maryland, Massachusetts, Illinois, District of Columbia In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws _._ * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care. Key Responsibilities Conduct prospective, concurrent, and retrospective drug utilization reviews. Evaluate prescribing patterns against clinical guidelines and formulary criteria. Identify potential drug interactions, duplications, and inappropriate therapy. Prepare recommendations for prescribers to optimize therapy and reduce risk. Document reviews and ensure compliance with state, federal, and health plan requirements. Contribute to quality improvement initiatives and pharmacy program development. What You'll Bring Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree. Licensure: Active and unrestricted pharmacist license in the U.S. Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply. Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication. Why This Role? Impact: Shape prescribing decisions that affect thousands of patients. Growth: Build expertise in managed care and population health pharmacy. Flexibility: Many DUR roles offer hybrid or fully remote schedules. Rewards: Competitive salary, benefits, and career advancement opportunities. About Us We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations. Apply Today Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.