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Utilization review nurse jobs in Trenton, NJ

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  • Hospital Infusion RN, Nurse Liaison

    Home Infusion 4.6company rating

    Utilization review nurse job in New Brunswick, NJ

    Job Title: Infusion RN Department Name: Home Infusion Status: Salaried Shift: Day Pay Range: $71,604.00 - $97,500.00 per year Pay Transparency: The above reflects the anticipated annual salary range for this position if hired to work in New Jersey. The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience. Job Overview: Coordinates the nursing component for home infusion therapies from the hospital setting., and acts as a resource person. Participates in program development, quality assurance and the delivery of care. Remains familiar with all pumps, access devices, drugs and central lines. Develops and maintains relationships with referral services and client base. Determines appropriateness of patients for home therapy. Does patient care when needed and on-call. Qualifications: Required: Current licensure by the New Jersey Board of Nursing as a Registered Professional Nurse. lV certification required. Successful completion of orientation programs. Preferred: PICC and Chemo certification preferred. Previous home care experience desired. Scheduling Requirements: Full-Time, Salaried position- 37.5 hours a week Monday - Friday 7.5 hour shifts On-call requirements as needed Essential Functions: Coordinates all patient discharges from the hospital including follow-up communication with the case manager. Coordinates nursing care with contracted nursing agencies. Coordinates nursing for Medicare/Medicaid recipients with a certified agency. Faxes MD orders, client info and completes. Coordination of Care with the nursing agency. Has a clear plan when emergencies arise and has the ability to cover patients in such situations. Has the ability to perform the field nurses' job when assigned. Increase referrals from hospital by 10% for the year. Makes arrangements for teaching to home infusion patients and caregivers as required, will complete teach in hospital when needed. Provides education to patients that will go home on subcutaneous medication. Provides education to transplant patients on oral medication regarding benefits and process for NBI and SBN4C. Provides nursing services for patients that need to be connected to medication prior to discharge. Receives and evaluates referrals for home care appropriateness for the nursing component for home infusion therapies. Understands and adheres to the company policy and requirements. EG: Snow day and sick time Understands and participates on different committees or plans. EG Emergency Operation Verities supplies needed with the pharmacy department, assists with coordination of the delivery times and communicates such with field R.N.'s. Willing to be cross trained to work or assist in other areas. Helps co-workers when appropriate. Willingness and flexible to work alternating work schedules on short notice. Will support management and do what is asked. Other Duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Benefits and Perks: At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees' physical, emotional, social, and financial health. Paid Time Off (PTO) Medical and Prescription Drug Insurance Dental and Vision Insurance Retirement Plans Short & Long Term Disability Life & Accidental Death Insurance Tuition Reimbursement Health Care/Dependent Care Flexible Spending Accounts Wellness Programs Voluntary Benefits (e.g., Pet Insurance) Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more! Choosing RWJBarnabas Health! RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health. RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey-whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education. Equal Opportunity Employer
    $71.6k-97.5k yearly 5d ago
  • Coordinating Nurse

    International Sos 4.6company rating

    Utilization review nurse job in Blue Bell, PA

    International SOS is the world's leading medical and security services company with over 12,000 employees working in 1,000 locations in 90 countries. We were founded on the principle of putting our clients' employees first and this is still true today. Led by 5,200 medical professionals and 200 security specialists our teams work night and day to find solutions to protect our clients and their employees in whatever situation they may be facing; we assess, advise and assist from a medical, security and logistical perspective on a global scale to protect and save lives and thereby enable our clients to achieve their business goals. As we've delivered on this mission over the last 35 years, we have become the market leader in global telehealth services and digital health solutions for an extensive client base of Fortune 500 companies, NGO's and governments around the world. We have an exciting opportunity for a Coordinating Nurse to join us in a dynamic office based clinical role where you will expand your medical and clinical knowledge whilst working across an international platform. You will be providing medical support to a worldwide client base across a variety of industries, focusing on quality, patient contact and, above all, care. This is a day-shift only position - no nights required. 3 days x 13 hour shifts or 4 days x 10 hour shifts available. On-site in our Blue Bell, PA office location. Key Responsibilities: Deliver front line telephonic triage to travelers Develop and enhance your understanding of global and travel health, and provide pre-trip travel advice to travelers Interpret medical situations by conducting a tailored risk analysis of condition vs. geographical location Provide evidence based medical advice and assessment, support and recommendations by speaking directly to patients and clients Liaise with international medical professionals to obtain medical assessments for patients who are hospitalized or being treated overseas Assess standards of care and provide guidance on travel following illness or injury Arrange complex medical evacuations and repatriations from all over the world Work within a truly international team - we have offices in 27 different countries you will interface with daily What we're looking for: Registered Nurse (must be currently registered in the US) Significant previous critical care or emergency medicine strongly preferred Broad Medical Knowledge - strong acute care background, primary care desirable Languages or further studies in travel health, global health or public health desirable Excellent written and spoken English language Good Computer skills; must type over 35 wpm Spanish speaking a plus
    $69k-90k yearly est. 4d ago
  • Graduate Nurse

    Encompass Health Rehabilitation Hospital of Toms River 4.1company rating

    Utilization review nurse job in Browns Mills, NJ

    GRADUATE NURSE/NURSE RESIDENCY PROGRAM Registered Nurse Residency Career Opportunity Encompass Health: Where Nursing Meets Heart, Home, and Healing Looking for a nursing career rooted inpurpose, close to your heart and home? At Encompass Health, you'll play a vital role in patients' recoveries-providing individualized, compassionate care that makes a lasting impact. Here, small victories add up to monumental change, and you'll thrive in an environment built on support, advanced resources, and teamwork. For new graduates or nurses with less than one year of experience, our 9-month Nurse Residency Program offers structured guidance and added support as you begin your career in rehabilitation nursing. With extended orientation, interdisciplinary shadowing, focused education, and an evidence-based project, the program sets you up for long-term success. Encompass Health is where nursing becomes more than a job-it's a meaningful contribution to your patients, your community, and yourself. A Glimpse into Our World At Encompass Health, you'll experience the difference the moment you become a part of our team. Being at Encompass Health means aligning with a rapidly growing national inpatient rehabilitation leader. We take pride in the growth opportunities we offer and how our team unites for the greater good of our patients. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For Award, among other accolades, which is nothing short of amazing. Starting Perks and Benefits Our benefits are designed to support your well-being and start on day one: Affordable medical, dental, and vision plans for both full-time and part-time employees and their families. Generous paid time off that accrues over time. Opportunities for tuition reimbursement and continuous education. Company-matching 401(k) and employee stock purchase plans. Flexible spending and health savings accounts. A vibrant community of individuals passionate about the work they do! Realize Your Vision as a New Registered Nurse Join a supportive RN cohort with a structured curriculum designed to build confidence, enhance your skills, provide mentorship and set you up for long-term success. Build meaningful relationships with patients and their families, understanding their unique needs to facilitate their recovery. Collaborate and communicate effectively with various departments to ensure coordinated care and provide direct patient care when needed. Celebrate victories and milestones achieved by our patients. Qualifications Valid RN licensures as required by state regulations. CPR certification (ACLS preferred). The Encompass Health Way We proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing! At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification. We're eager to meet you, and we genuinely mean that. Join us on this remarkable journey!
    $61k-88k yearly est. 2d ago
  • Utilization Review Coordinator

    The Renfrew Center 4.1company rating

    Utilization review nurse job in Philadelphia, PA

    Job DescriptionDescription: The Renfrew Center of Philadelphia, offers an unmatched opportunity, in the field of eating disorders, for a Utilization Review Coordinator to work in an environment that changes lives. The Renfrew Center has opportunities for individuals of all backgrounds, that have the desire and passion to foster a positive outcome and impact on our patients' lives. The Renfrew Center's research-based treatment model, for eating disorders, is focused on treating the whole person and helping them lead a rich and fulfilling life. Our commitment to you - We are committed to providing every employee the opportunity for personal and professional development through: 401(k) with company match Healthcare benefits Vacation and sick days Employee referral program Employee discounts to various stores, amusement parks, events, etc. Continuing education (CE) programs and training Advancement opportunities within the organization Position Responsibilities: Complete daily treatment pre-certifications with insurance/managed care companies. Complete daily concurrent reviews with insurance/managed care companies. Understand and present acuity, rationale for continued stay, treatment goals and discharge criteria from a medical record. Be familiar with various managed care companies medical necessity criterion and appropriate application, to guide the concurrent review process. Maintain accurate and complete documentation, including computer documentation. Participate and effectively collaborate with a treatment team as an active team member. Demonstrate an understanding of the functional/developmental age of the individual served. Requirements: Education, Competencies and Credentials: Master's degree in Human Services, Psychology, or Social Work required. A minimum of 1-2 years of training/working in a residential or health care facility is required. Previous experience working with eating-disorder patients is highly preferred. Familiarity with psychiatric disorders is required. Hours: 40 hours per week, Monday through Friday. The Renfrew Center provides women with the tools they need to succeed - in recovery and life. Offering a warm, nurturing environment, Renfrew emphasizes respect for the unique psychology of women, the importance of a collaborative, therapeutic relationship, and the belief that every woman needs to actively participate in her growth and recovery. The Renfrew Center - An Equal Employment Opportunity Employer, devoted to diversity, equity, and inclusion.
    $34k-46k yearly est. 28d ago
  • Utilization Review RN

    Healthcare Support Staffing

    Utilization review nurse job in Philadelphia, PA

    HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description • Evaluate clinical information submitted by providers against plan review criteria and benefit guidelines • Utilize clinical information to determine if criteria for medical necessity and benefit guidelines are met • Document pertinent case information for approvals and denials- refer cases failing to meet Interqual to Medical Director • Act as liaison to ensure services are provided in the least restrictive, most cost effective and clinically appropriate setting • ID and resolve problems that could interfere with provider's continuity and coordination of care of members- refer unresolved problems to the manager Qualifications • Clear and active RN license in state of PA • Minimum AS in nursing • 2 years' experience in acute care hospital AND • 2 years' experience in managed care, quality assurance or utilization review setting Additional Information Hours for this Position: 40 hours a week M-F, daytime hours Advantages of this Opportunity: • Competitive salary, negotiable based on relevant experience • Benefits offered, Medical, Dental, and Vision • Fun and positive work environment • Right to Hire opportunity • Can start as early as next week Interested in being considered? If you are interested in applying to this position, please contact Steph Zymowski at 407-636-7030 ext.220 and click the Green I'm Interested Button to email your resume.
    $65k-89k yearly est. 60d+ ago
  • Utilization Review Nurse

    Berkshire Hathaway 4.8company rating

    Utilization review nurse job in Conshohocken, PA

    About us: Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide. Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path! Benefits: We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer! Competitive compensation Healthcare benefits package that begins on first day of employment 401K retirement plan with company match Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays Up to 6 weeks of parental and bonding leave Hybrid work schedule (3 days in the office, 2 days from home) Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation) Tuition reimbursement after 6 months of employment Numerous opportunities for continued training and career advancement And much more! Responsibilities The Utilization Review Nurse's duties will include, but are not limited to: Support internal claims adjusting staff in the review of workers' compensation claims Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone Meet required decision-making timeframes Clearly document all communication and decision-making within our insurance software system Establish collaborative relationships and work as an intermediary between clients, patients, employers, providers, and attorneys Utilize good clinical judgment, careful listening, and critical thinking and assessment skills Track ongoing status of all UR activity so that appropriate turn-around times are met Maintain organized files containing clinical documentation of interactions with all parties of every claim Send appropriate letters on each completed UR Qualifications Active Licensed Practical Nurse and/or Registered Nurse License 1+ years of utilization review experience at a managed care plan or provider organization 2 + years' clinical experience preferably in case management, rehabilitation, orthopedics, or utilization review Excellent oral and written communication skills, including outstanding phone presence Strong interpersonal and conflict resolution skills Experience in a fast-paced, multi-faceted environment The ability to set priorities and work both autonomously and as a team member Well-developed time-management and organization skills Excellent analytical skills Working knowledge of: Microsoft Word, Excel, and Outlook
    $74k-93k yearly est. Auto-Apply 10d ago
  • Utilization Management Nurse

    Centerwell

    Utilization review nurse job in Trenton, NJ

    **Become a part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others. **Use your skills to make an impact** **Required Qualifications** + Active unrestricted RN license with the ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work independently and within a team setting + Willing to work in multiple time zones + Strong written and verbal communication skills + Attention to detail, strong computer skills including Microsoft office products + Ability to work in fast paced environment + Ability to form positive working relationships with all internal and external customers **Preferred Qualifications** + Education: BSN or bachelor's degree in a related field + Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. + Bilingual **Alert** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. **Interview Format - HireVue** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. **Work-At-Home Requirements** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **Benefits** Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: + Health benefits effective day 1 + Paid time off, holidays, volunteer time and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer match + Tuition assistance + Scholarships for eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-25-2025 **About us** About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************
    $71.1k-97.8k yearly Easy Apply 29d ago
  • Field Nurse Practitioner - Mercer County, NJ

    Advantmed 3.6company rating

    Utilization review nurse job in Trenton, NJ

    Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations. The building B.L.O.C.K.S. of our team's success! Bring the fun Leverage together for better Outperform yourself Care at every touchpoint Keep your word. Keep it real Stay curious & listen well Primary Purpose: We are proud of the quality care we provide members and our team is rapidly expanding to meet the demands of our growing business; we are seeking a highly skilled and compassionate certified Nurse Practitioner to join our Advantmed provider network. In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare members and other at risk populations. Your primary objective will be to assess the overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care. This role is 1099 (PRN) and offers tremendous flexibility and opportunity for those who are balancing competing priorities. Learn more about our primary purpose here Follow us on LinkedIn: ****************************************** NP Responsibilities: Perform annual in-home wellness visits and risk adjustment health assessments on a population with chronic conditions; Our thorough evaluations include: a comprehensive assessment, physical examination, body system review, vital signs, review of medication history, review of current prescriptions, review of member functional status, pain management, cognitive assessment, review of the home environment, fall risk screening, social assessment, review of daily living activities, mental health screening, documentation and communication You will play a pivotal role in providing individualized quality care to the elderly population in their homes Deliver patient health education on topics such as pain management, medication, etc. Build relationships of trust with members through exceptional communication and empathy Assist in closing quality care gaps (i.e. screenings and labs) An enthusiastic collaborator contributing to the enhancement of care delivery Providers are expected to commit a minimum of 30 hours per month Locations: Mercer County, NJ Requirements NP Qualifications: Must have a valid unencumbered NP License for the state you will be working in This role requires travel within the assigned job posting county up to a maximum 55-mile radius Previous in-home risk assessment experience preferred Previous 1099 (PRN) experience is preferred but not required 3 years patient care experience preferred (primary care/adult/geriatric, EMR) May be requested to obtain additional NP licensure supported by Advantmed Access to reliable transportation that will enable you to travel to member's homes within a designated area Strong ability to work within our EMR system Ability to work independently Bilingual is a plus Benefits Advantmed offers: Competitive compensation of ~$100 per completed in-home health assessment Paid mileage Flexible work schedule Evening and weekend availability Never on-call Visits ready to be scheduled immediately Appointment confirmation support Dedicated coordinator support Advanced member scheduling coverage State of art technology
    $100 hourly Auto-Apply 27d ago
  • Utilization Management Nurse

    Us Tech Solutions 4.4company rating

    Utilization review nurse job in Hopewell, NJ

    **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.
    $68k-87k yearly est. 60d+ ago
  • Utilization Review RN

    Capital Health 4.6company rating

    Utilization review nurse job in Hopewell, NJ

    Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed minimum pay reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Minimum Pay: $38.63 Position Overview Performs chart review of identified patients to identify quality, timeliness and appropriateness of patient care. Conducts admission reviews for Medicare, Medicaid beneficiaries, as well as private insurers and self pay patients, based on appropriate guidelines. Uses these criteria guidelines to screen for appropriateness for inpatient level of care or observation services based on physician certification (physicians H&P, treatment plan, potential risks and basis for expectation of a 2 midnight stay). Refers cases as appropriate, to the UR physician advisor for review and determination. Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis. Performs concurrent and retrospective clinical reviews with various payers, utilizing the appropriate guidelines as demonstrated by compliance with all applicable regulations, policies and timelines. Adheres to CMS guidelines for utilization reviews as evidenced by utilization of the relevant guidelines and appropriate referrals to the physician advisor and the UR Committee. Identifies, develops and implements strategies to reduce length of stay and resource consumption. . Confers proactively with admitting physician to provide coaching on accurate level of care determinations at point of hospital entry. Keeps current on all regulatory changes that affect delivery or reimbursement of acute care services. Uses knowledge of national and local coverage determinations to appropriately advise physicians. Understands and applies federal law regarding the use of Hospital Initiated Notice of Non-Coverage (HINN) and Lifetime Reserve Days letters. Identifies and records consistently any information on any progression of care or patient flow barriers using the Avoidable Days tool in the Utilization software program. Consults with medical staff, care team and case managers as necessary to resolve immediate progression of care barriers through appropriate administrative and medical channels. Engages care team colleagues in collaborative problem solving regarding appropriate utilization of resources. Recognizes and responds appropriately to patient safety and risk factors. Represents Utilization Management at various committees, professional organizations an physician groups as needed. Promotes the use of evidence based protocols and or order sets to influence high quality and cost effective care. Identifies, develops and implements strategies to reduce lengths of stay and resource consumption in the patient population. Participates in performance improvement activities. Promotes medical documentation that accurately reflects findings and interventions, presence of complication or comorbidities, and patient's need for continued stay. Identifies and records episodes of preventable delays or avoidable days due to failure of progression of care processes. Maintains appropriate documentation in the Utilization software system on each patient to include specific information of all resource utilization activities. Participates actively in daily huddles, patient care conferences, and hospitalist or nurse handoff reports to maintain knowledge about intensity of services and the progression of care. Identifies potentially wasteful or misused resources and recommends alternatives if appropriate by analyzing clinical protocols. Maintains related continuing education credits = 15 per calendar year. MINIMUM REQUIREMENTS Education: Minimum of Associate's degree in Nursing. Graduate of an accredited school of nursing. CPHQ, CCM or CPUR preferred. Experience: Three years of clinical nursing or two years quality management, utilization review or discharge planning experience. Other Credentials: Registered Nurse - NJ Knowledge and Skills: Three years of clinical nursing or two years quality management, utilization review or discharge planning experience. CPHQ, CCM or CPUR preferred. Special Training: Basic computer skills including the working knowledge of Microsoft Office, UR software and EMR. Possesses familiarity with MCG guidelines. Mental, Behavioral and Emotional Abilities: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Usual Work Day: 8 Hours PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent physical demands include: Sitting , Standing , Walking Occasional physical demands include: Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Keyboard use/repetitive motion , Talk or Hear Continuous physical demands include: Lifting Floor to Waist 10 lbs. Lifting Waist Level and Above 5 lbs. Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Color Discrimination, Accurate Depth Perception, Accurate Hearing Anticipated Occupational Exposure Risks Include the following: N/A Offers are contingent upon successful completion of our onboarding process and pre-employment physical. Capital Health will require all applicants to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions. "Company will never ask candidates for social security numbers or date of birth during application phase. If you are asked for this information online, you may be a target for identity theft." For benefit eligible roles, in addition to cash compensation, we provide a comprehensive and highly competitive benefits package, with a variety of physical health, retirement and savings, caregiving, emotional wellbeing, transportation, robust PTO plan, overtime to eligible roles, and other benefits, including "elective" benefits employees may select to best fit the needs and personal situations of our diverse workforce. The pay rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.
    $38.6 hourly Auto-Apply 60d+ ago
  • Nurse Case Manager needed in Philadelphia, PA

    Healthplus Staffing 4.6company rating

    Utilization review nurse job in Philadelphia, PA

    HealthPlus Staffing is seeking a Nurse Case Manager in Philadelphia, PA. The Case Manager will provide help to pregnant women and children in getting the health care and social services needed. Job Requirements: Bachelor's degree with major course work in sociology, social work, social welfare, psychology, gerontology, anthropology, other related social sciences, criminal justice, theology, nursing, healthcare administration, counseling, or education or Registered Nurse Licensed Practical Nurse or Certified Nurse Assistant (CNA) or Medical Assistant plus two (2) years of mental health direct care experience. Individuals using these criteria must receive a written waiver from the DBHIDS prior to hire. Must have Active nurse License in the state of Illinois Compensation: Commensurate on experience Benefits: Full Benefits Pediatrics Schedule: Monday to Friday Location: Philadelphia, PA Reliably commute or planning to relocate before starting work (Required) Education: Bachelor's (Preferred) Experience: Nursing: 1 year (Preferred) For more info please reach out to us at Recruitment@HealthPlusStaffing.com or call at 561-291-7787
    $75k-97k yearly est. 60d+ ago
  • Hospice Nurse Case Manager (Philadelphia, PA)

    I4 Search Group Healthcare

    Utilization review nurse job in Philadelphia, PA

    Job Description Hospice Nurse Case Manager Full-time | Philadelphia, PA | Monday-Friday with occasional on-call rotation We are seeking a compassionate and experienced Hospice Nurse Case Manager to join a dedicated interdisciplinary team providing high-quality end-of-life care to patient's in their residence. The ideal candidate is a skilled clinician who thrives on building strong relationships with patients and families, coordinating care plans, and ensuring that each individual's final journey is met with dignity, comfort, and compassion. You'll be joining a passionate teams of physicians, NPs, chaplains, social workers, and aides. Responsibilities: Manage a caseload of hospice patients, conducting comprehensive assessments and developing individualized care plans. Provide direct skilled nursing care and education to patients and caregivers in the home setting. Coordinate care with physicians, social workers, chaplains, and other members of the hospice team to ensure holistic, patient-centered care. Monitor patient status and adjust care plans as needed to maintain optimal comfort and symptom management. Document assessments, interventions, and communications in accordance with state, federal, and agency guidelines. Serve as a clinical resource and advocate for patients and families, ensuring their physical, emotional, and spiritual needs are met. Participate in regular interdisciplinary team meetings and case conferences. Rotate in after-hours or weekend on-call coverage as assigned. Qualifications: Current Registered Nurse (RN) license in the state of Pennsylvania Minimum of 1-2 years of hospice or home health nursing experience strongly preferred. Strong clinical assessment, communication, and organizational skills. Empathetic, patient-centered approach with the ability to support families during emotionally challenging times. Valid driver's license, reliable transportation Benefits: Competitive salary and mileage reimbursement Comprehensive health, dental, and vision insurance Paid time off and retirement plan options Ongoing training and professional development opportunities Supportive and collaborative work environment
    $67k-96k yearly est. 14d ago
  • MDS Nurse/Coordinator (RN or LPN)

    QRM Health

    Utilization review nurse job in Trenton, NJ

    Job Description Pay: $80,000.00 - $115,000.00 per year Accela Post Acute Care at Hamilton is currently seeking a dedicated and experienced MDS Nurse to join our team on a full-time, onsite basis. Located on a hospital campus, our 55-bed facility specializes exclusively in short-term rehabilitation and skilled nursing care. We offer a supportive and collaborative work environment, led by a committed management team focused on clinical excellence and staff well-being. Position Highlights: No floor nursing responsibilities Manager-on-duty rotation only once every 6-8 weeks Supportive interdisciplinary team Competitive work environment focused on quality outcomes Previous experience is required Key Responsibilities: Complete and submit MDS assessments timely and accurately under the PDPM reimbursement model Collaborate with interdisciplinary team members to improve coding accuracy, documentation quality, and workflow efficiency Identify barriers to performance improvement affecting quality measures, Five-Star ratings, and reimbursement Provide staff education on RAI process best practices and compliance Analyze clinical data and KPIs to monitor success and address areas needing improvement Conduct audits of assessments and documentation to ensure regulatory compliance Support the facility in maintaining excellence in care outcomes and survey readiness Qualifications: Current New Jersey RN or LPN license (required) MDS experience under the PDPM model (required) RAC-CT certification (preferred) Strong understanding of Medicare and Medicaid reimbursement systems Proficiency with Microsoft Office and electronic medical records Exceptional attention to detail and organizational skills Strong communication and collaboration skills Ability to work independently and as part of a team in a fast-paced environment Why Join Us? Supportive leadership and team culture Opportunities for professional growth and continuing education Competitive salary and benefits package If you're an experienced MDS nurse passionate about clinical documentation, reimbursement integrity, and quality resident care - we'd love to hear from you! Apply today to join our dedicated team at Accela Post Acute Care at Hamilton. #IND1
    $80k-115k yearly 5d ago
  • Registered Nurse - Nurse Coordinator

    Greater Philadelphia Health Action 4.1company rating

    Utilization review nurse job in Philadelphia, PA

    As our community evolves, so does the need for compassionate care. If your position was recently impacted, Greater Philadelphia Health Action, Inc., invites you to continue your mission of service with us. Founded in 1970 as South Philadelphia Health Action and subsequently incorporated as Greater Philadelphia Health Action, GPHA is a non-profit healthcare organization with a commitment to provide compassionate and affordable healthcare services regardless of an individual's ability to pay. Since 1970, GPHA has expanded to become one of the premier providers of primary and behavioral healthcare in the Greater Philadelphia area. GPHA offers GREAT PAY, Performance BONUSES, Comprehensive Medical, Dental, Vision, Life, and LTD Insurance. We also offer 401k with a very lucrative company match, Employee Assistance and Self-Care, and Professional Activity, Educational, and Tuition Reimbursements, Paid Vacation, Paid Sick, Paid Personal Days, Paid Educational Days, Holiday Pay, Loan Forgiveness, and Free Malpractice Insurance. We are presently seeking full-time Registered Nurses (RN's) in our Medical Division. These positions offer potential for clinical and managerial professional growth. Qualified candidates have: Graduated from an accredited program in nursing; Active, licenses as an RNs in the Commonwealth of Pennsylvania; At least two (2) years clinical experience in an ambulatory setting preferred, OB/GYN experience a plus; Current CPR certification; Creativity; Experience in working with diverse populations; Good oral and written skills; Foreign language skills (Chinese, French, Spanish skills a plus). GPHA RNs: Utilize clinical judgment to increase access to care and maximize clinical outcomes; Coordinate patient flow and service provision so that clinical and productivity objectives are met and/or exceeded; Perform timely and accurate assessment and assignment of “walk-in” and appointment patients according to policy document; Provide direct clinical services in accordance with Nursing Protocols, Clinical Policies and Procedures and other departmental/ corporate policy, procedure and protocol manuals; Obtain complete age/gender-appropriate patient histories; Coordinate office visit preparation for patients with complex needs; Provide counseling and health education to patients and their families according to need, provider orders or patient request, including but not limited to pre- and post-HIV antibody test counseling and HIV related medication adherence assessment/counseling, prenatal education and smoking cessation; Assess completeness of care; Work collaboratively with providers, allied health and support staff to ensure treatment plans are implemented Join a network that values dedication, balance, and purpose. At Greater Philadelphia Health Action, Inc. (GPHA), we respect diversity and promote equity through action, advocacy, and policy through a dedicated team of representatives committed to listening, learning, and enacting systemic change. We create different channels, outlets, and programs to enhance safe spaces within GPHA, creating a shared understanding and language around justice, diversity, equity, and inclusion. GPHA is an Equal Opportunity Employer. GPHA does not and will not discriminate in employment and personnel practices to include hiring, transferring and promotion practices on the basis of race, color, sex, age, handicap, disability, religion, religious creed, ancestry, national origin, or any other basis prohibited by applicable law.
    $72k-84k yearly est. Auto-Apply 60d+ ago
  • Interventional Radiology Nurse (RN)

    ATC-South Jersey Locations

    Utilization review nurse job in New Brunswick, NJ

    Job Description Interventional Radiology RN - $76/hr | Day Shift | 13-Week Contract Shift: 4x10s (8:00 AM-6:30 PM) Pay: $76/hr Contract Length: 13 Weeks About the Role: Support IR procedures at the Morris Cancer Center and Main Hospital Campus Deliver conscious sedation recovery care Float between campuses 2-3 days/week on-call (PICC procedures) Work with specialty equipment: EKOS+, A-line, procedural wedge pressures, portable midlines Requirements: 2+ years in a stroke center (Level I or II) ED or ICU background strongly preferred Confident using specialty equipment & serving as Primary RN Certs: BLS, ACLS, NIHSS License: NJ or compact license at time of submission Ready to make an impact with a team that values your skill and commitment? Apply today and work with a staffing agency that treats you like family - ATC Healthcare of NJ.
    $76 hourly 1d ago
  • Nurse Case Manager

    Shared Wellness

    Utilization review nurse job in Warrington, PA

    Job Details Shared Wellness Center - Warrington, PA Full Time 4 Year Degree $75000.00 - $75000.00 Salary/year Up to 25% Any Health CareDescription At Shared Wellness, our philosophy is centered on creating a supportive and inclusive environment where individuals can thrive in both body and mind. We integrate traditional healthcare practices with innovative approaches to ensure that every person receives the care they need. As the Director of Nursing, you will play a key role in helping us achieve our mission of fostering well-being through person-centered care and community engagement. Our core principles-such as inclusivity, accessibility, cultural humility, and a commitment to compassion-guide everything we do. As part of the Shared Wellness team, you'll help individuals on their unique journeys, empowering them to live balanced, healthy lives. You'll work in a collaborative environment, providing support that respects each person's strengths, goals, and cultural background. We invite you to join our team, where your compassion and commitment to quality care will contribute to making a positive difference in the lives of those we serve. At Shared Wellness, we believe everyone deserves compassionate, person-centered care.Our nurses play a vital role in helping adults with intellectual disabilities achieve health, independence, and dignity within their homes and communities. Join a team that values empathy, teamwork, and the joy of meaningful impact Qualifications What You'll Do • Provide health oversight, medication management, and wellness coordination for individuals in supported living programs. • Collaborate with interdisciplinary teams to create holistic care plans. • Educate direct support staff on health and safety protocols. • Monitor medical appointments, follow-up care, and health documentation. • Serve as an advocate for each person's health and quality of life. What We Offer • Competitive pay and comprehensive benefits (medical, dental, vision) • Generous PTO and 401(k) with employer contribution • Flexible scheduling options - full-time, part-time, or per diem • Supportive, team-based environment where your voice matters • Continuing leadership development opportunities • Work that makes a difference - every day Who You Are • Licensed LPN in the State of Pennsylvania • Passionate about person-centered care and community health • Able to work independently and collaboratively • Organized, compassionate, and committed to advocacy Apply today and bring your heart to Shared Wellness - where caring is our calling.
    $75k-75k yearly 60d+ ago
  • Part Time IV Infusion Nurse (RN)

    RHWM034

    Utilization review nurse job in Lawrenceville, NJ

    Benefits: Competitive salary Employee discounts Training & development Wellness resources Benefits/Perks A competitive salary Flexible Schedules Casual Dress-code Fun, wellness-focused work environment Company OverviewRestore Hyper Wellness is the leading retail provider of alternative health and wellness modalities in the United States. Our goal is to make Hyper Wellness widely accessible, affordable, and fun. This means helping people from all walks of life feel better and perform at a higher level so they can do more of what they love in life. Inc. 5000 ranked Restore as the #113 Fastest Growing Company in America, the #17 Fastest Growing Company in Texas, and the #1 Hottest Franchise in America. Job SummaryDo you have a passion for nursing but are tired of the hectic, high-stress environment of a clinic or ER? This is your chance to take your career in an exciting, new direction. Restore is seeking an outgoing, experienced Nurse to join our team of wellness professionals on a mission to help people feel better so they can do more of what they love. We're the antithesis of a traditional medical office or clinic, offering innovative wellness services in a fun, comfortable environment. Our nurses have described working for Restore as “the most fun you can have at a nursing job while still helping people in a meaningful way.” This is your opportunity to take an active role in assisting individuals on their health and wellness journey and leading a team of nurses to support the Restore mission. Responsibilities Medical Operations & Clinical Duties Administer IV Drip Therapy and Intramuscular (IM) Shots to deliver our menu of vitamins, minerals, and antioxidants. Educate clients on the qualities and benefits of our IV Drip and Intramuscular (IM) Shot ingredients. Administer Hyperbaric Oxygen Therapy sessions. Utilize blood test offerings to help clients optimize their wellness. Promote memberships and medical services based on client needs. Document client visits via electronic medical records. Address and answer client questions using the Restore Nursing Reference Guide under the supervision of the Medical Director and network of licensed Advanced Practice Providers. Communicate to the medical compliance team any issues or adverse effects clients experience. Provide therapeutic communication along with exceptional customer service Assist staff with store services. Assist with off-site nursing events and special projects. This position reports to the Lead Nurse. Maintain a safe and clean working environment. Qualifications You're a licensed Registered Nurse (RN). You have at least two years of experience as a nurse in an acute care setting (ER, ICU, Med-Surg, or similar). You are BLS (Basic Life Support) certified You have at least one year of experience administering injections. You're comfortable using electronic medical records to document client details. You maintain a non-judgemental outlook and have a demonstrated ability to work with a diverse clientele. Your verbal and written communication skills are on point. You value ethics and integrity. You embrace a team environment and also excel at working independently. You're willing to adhere to all policies and procedures and understand the importance of maintaining medical compliance. Compensation: $39.00 - $42.00 per hour Restore Hyper Wellness is the award-winning industry leader and creator of an innovative new category of care-Hyper Wellness . Restore delivers expert guidance and the most extensive array of cutting-edge modalities available under one roof. With over 100+ locations nationwide and a fast-growing retail footprint, Restore is making true health more accessible than ever before. Restore is one of America's fastest-growing companies right now, and for good reason. Inc. 5000 just named Restore the #1 hottest franchise in America, and #113th company in America. We are on a blazing mission to restore people's health and wellness so that they can do more of what they love every day. Our daily metric? How many people we helped that day. That's why it is paramount that we attract people who are as passionate about helping people as we are. Join us on our mission to help people feel better so they can do more of what they love. This franchise is independently owned and operated by a franchisee. Your application will go directly to the franchisee, and all hiring decisions will be made by the management of this franchisee. All inquiries about employment at this franchisee should be made directly to the franchise location, and not to Restore Hyper Wellness.
    $39-42 hourly Auto-Apply 60d+ ago
  • Wellness Nurse (LPN) Full-Time

    Monarch Communities 4.4company rating

    Utilization review nurse job in Princeton, NJ

    Monarch/Brandywine Senior Living Company Culture and Values: At Monarch Communities, we value compassion, innovation, and community. Our team is committed to making a meaningful impact on the lives of our residents and fostering a collaborative and supportive work environment. Job Description LPN - Brandywine Living - Livingston, NJ Salary: $36.00 - $38.00 Hourly Led by the community's Health and Wellness Director (RN), our Wellness Nurse is a Licensed Practical Nurse (LPN) who provides direct nursing care to the Residents with an emphasis on holistic wellness. They also help supervise the day-to-day nursing activities performed by care staff of Certified Nursing Assistants. Schedule: The Wellness Nurse (LPN) is Full-Time: 11pm-7am Responsibilities and Duties Monitors the health, safety, and well-being of all residents Assisting in training and monitoring of medication administration Supervise care staff in accordance with current state regulations and community policies Maintaining clinical quality assurance in accordance with federal, state and local standards Promote the highest degree of service to our residents while leading and demonstrating the mission of the company Conduct thorough resident assessments Qualifications Graduation from an accredited School of Nursing, with current LPN license At least 2 years' experience with long-term care, assisted living, home health or hospital setting preferred Experience working with residents with Alzheimer's or other related dementias Ability to handle multiple tasks Knowledge of federal and state regulations, and of nursing practices, techniques and methods applied to health and wellness resident Proficiency in computer skills, Microsoft Office (Windows, Outlook, Excel) with the ability to learn new applications While performing the duties of this job, the associate is often required to stand, walk, sit, use fine and gross motor skills, reach with hands and arms, balance, stoop, kneel, crouch, talk, hear, and smell. An individual in this position will be required to lift or carry weight in up to 50 lbs. Intermittent physical activity includes lifting and supporting residents. The associate must use proper body mechanics. Additional Information Benefits Offered(Full Time): Health Insurance: Medical/Rx, Dental, and Vision Ancillary Benefits: Life Insurance/AD&D, Short Term Disability and Long-Term disability Basic Life & Accidental Death & Dismemberment (AD&D) Insurance FSA (Commuter/Parking) Employee Assistance Program (EAP) 401(k) Retirement with Company Match Paid Time Off (PTO) and Holidays Tuition Reimbursement Other Compensation Programs: Employee Referral Bonus Resident Referral Bonus Equal Opportunity Statement: Monarch Communities and Brandywine Senior Living is an Equal Opportunity Employer. We comply with all applicable federal, state, and local laws. We celebrate diversity and are committed to creating an inclusive environment for all employees.
    $36-38 hourly 26d ago
  • Infusion Nurse

    Dev 4.2company rating

    Utilization review nurse job in Willingboro, NJ

    Company DescriptionJobs for Humanity is partnering with Cooper University Health Care to build an inclusive and just employment ecosystem. Therefore, we prioritize individuals coming from the following communities: Refugee, Neurodivergent, Single Parent, Blind or Low Vision, Deaf or Hard of Hearing, Black, Hispanic, Asian, Military Veterans, the Elderly, the LGBTQ, and Justice Impacted individuals. This position is open to candidates who reside in and have the legal right to work in the country where the job is located. Company Name: Cooper University Health Care Job Description About us At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to its employees by providing competitive rates and compensation, a comprehensive employee benefits programs, attractive working conditions, and the chance to build and explore a career opportunity by offering professional development. Discover why Cooper University Health Care is the employer of choice in South Jersey. Short Description Clinical application of the knowledge and skill in the following areas: Pharmacology, principals and application of chemotherapy administration, side effects and appropriate nursing intervention, chemotherapy, liaison for patients/families receiving treatment. Evaluates patients in need of intravenous treatment or medication and plans, implements and documents nursing care. Determines appropriate venipuncture site and administers intravenous therapeutic treatments, which includes chemotherapy/biotherapy, blood components, fluid and electrolyte replacements, and other oncology treatments as prescribed. Provides information and education to patients and families regarding intravenous treatment and/or side effect management. Experience Required 3 years of oncology experience preferred. Education Requirements BSN; Graduate of NLN accredited School of Nursing. License/Certification Requirements Current NJ-RN License (Registered Nurse); Curretn NJ-BLS Certification (Basic Life Support) Oncology Nursing Society Chemotherapy/Biotherapy certification (ONS ONCC) within 8 weeks of hire.
    $50k-72k yearly est. 60d+ ago
  • Nurse - Full Time Nights- Willow Grove

    Progressions 3.7company rating

    Utilization review nurse job in Willow Grove, PA

    Job Details Entry Willow Grove - Willow Grove, PA Undisclosed N/A Full Time 2 Year Degree Undisclosed None Day NurseDescription Malvern Treatment Centers is seeking a Full-Time Nurse to join our team at our Willow Grove location! We have various positions open for full time night shift. The full time positions are benefit eligible offering shift differentials and a competitive salary with a comprehensive benefits package including medical insurance, paid time off and a 401K with company match. Position Summary: Organizes and administers individualized, professional patient care. Provides nursing care as directed by the Nurse Manager and medical staff in accordance with the multidisciplinary treatment plan objectives, policies, and procedures of Malvern Treatment Centers and the Nurse Practice Act. Summary of Essential Position Functions: Promotes the safety/health and well-being of patients. Identifies and provides written assessment of patients on admission and throughout treatment. Documents current needs/problems and past medical, psychiatric, drug and alcohol history. Assessment addresses bio-psychosocial needs. Completes a multi-disciplinary assessment when needed. Documents in electronic record as directed. Identifies and evaluates patients' learning needs, ability and readiness to learn. Documents appropriately. Ensures that they are addressed during treatment. Formulates and utilizes a written nursing care plan, based on diagnosis, special patient outcomes, and appropriate nursing measures. Integrates plan with multidisciplinary team and patient, including medical problems, medication, diet, and self care needs. Demonstrates appropriate application of nursing skills during detoxification by assessing the patient's needs for medication based on withdrawal symptoms as ordered by the physician. Administers and accounts for of medications and controlled drugs in the appropriate place. Orders new medications and replaces stock medications. Provides for patient safety through preventative measures. Implements fire safety, infection control and isolation procedures when appropriate, including disposal of hazardous waste. Responds to and directs emergency situations as necessary. Oversees and assists in providing instruction for patients, including explanation of procedures, treatments, medications. Provides educational literature to patients and meets with them individually. Responds to and implements special precautions/interventions for suicidal, homicidal, or aggressive patients until patient can be transferred. Provides instruction for patients, including explanations of procedures, treatments, medications and documents learning. Assesses, evaluates and revises the written plan of care, ensuring identification of problems as well as patient response to interventions. Delegates duties to staff members appropriately after assessing patients' needs and varying skill level of staff members. Obtains and transcribes physician orders in an accurate and timely fashion. Carries them out in a timely manner. Participates in continuing education to reach professional growth objectives, including performing nursing audits, peer reviews and participating in committees. Acts as a resource person regarding patient care, specialty areas (setting up consults, calling for study results). Follows all infection control practices. Prepares and certifies the accuracy of the midnight census. Benefits This position is a full time, benefit eligible position. Benefits offered include, but not limited to: Medical Insurance Dental Insurance Vision Insurance Life Insurance Paid Time Off 401K plan with company match Free Meal (On Site) Qualifications Qualifications: To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. This position requires individuals that are client focused; team oriented; great interpersonal and communication skills; flexible to sudden changes in workload, emergency or staffing; dependable; problem solving skills; focused on compliance and performance quality. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may Education and/or Experience: Current licensure as a nurse in PA. Clinical experience in the treatment of addiction is preferred. Current CPR certification. Knowledge of Bureau of Drug and Alcohol Program and Commission of Accreditation for Rehabilitation Facilities standards. Technical/Computer Skills: Ability to work in a supportive, caring and non-judgmental manner with staff and patients in order to gain confidence and cooperation with patients Ability to care plan and identify appropriate nursing interventions. Microsoft Office Proficient. EMR experience preferred. Work Environment and Hazards: No hazardous conditions. Protected from weather conditions. Risk of exposure to communicable diseases. Possible exposure to intoxicated, disruptive and agitated patients. Emergency Classification: Essential Personnel Physical Requirements: Light work - lifting 25 lbs maximum. Involves sitting and a certain amount of walking and standing occasionally to carry out job functions. Travel Required: No *Malvern Health, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.*
    $55k-79k yearly est. 57d ago

Learn more about utilization review nurse jobs

How much does a utilization review nurse earn in Trenton, NJ?

The average utilization review nurse in Trenton, NJ earns between $58,000 and $106,000 annually. This compares to the national average utilization review nurse range of $47,000 to $89,000.

Average utilization review nurse salary in Trenton, NJ

$78,000

What are the biggest employers of Utilization Review Nurses in Trenton, NJ?

The biggest employers of Utilization Review Nurses in Trenton, NJ are:
  1. AmeriHealth Caritas
  2. Centerwell
  3. Capital Health
  4. Centene
  5. US Tech Solutions
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