Utilization review nurse jobs in Woodbridge, NJ - 372 jobs

Seeking a Hematology - Oncology NP/PA to join a permanent practice in New York Experienced APC preferred Provider must have Hem Onc experience Located near Bronx, NY If you are interested in hearing more about this opportunity, please call or text HDA at ************. You can also reach us via email at *********************. Please reference Job ID #j-107584.

About Abridge Abridge was founded in 2018 with the mission of powering deeper understanding in healthcare. Our AI-powered platform was purpose-built for medical conversations, improving clinical documentation efficiencies while enabling clinicians to focus on what matters most-their patients. Our enterprise-grade technology transforms patient-clinician conversations into structured clinical notes in real-time, with deep EMR integrations. Powered by Linked Evidence and our purpose-built, auditable AI, we are the only company that maps AI-generated summaries to ground truth, helping providers quickly trust and verify the output. As pioneers in generative AI for healthcare, we are setting the industry standards for the responsible deployment of AI across health systems. We are a growing team of practicing MDs, AI scientists, PhDs, creatives, technologists, and engineers working together to empower people and make care make more sense. We have offices located in the Mission District in San Francisco, the SoHo neighborhood of New York, and East Liberty in Pittsburgh. The Role Abridge is seeking a Nurse Scientist to drive the development of our AI-powered nursing documentation tools. The ideal candidate is a current/former Practicing Nurse with a strong background in Nursing Informatics and technical expertise, blending clinical knowledge with experience using informatics to drive the development of new technologies. In this role, you will help shape AI-driven documentation tools, ensuring our models generate accurate, high-quality nursing notes that enhance nurses' efficiency and patient care. You'll work closely with engineers, researchers, and other clinicians to refine AI models, validate outputs, and develop new capabilities that improve documentation workflows. This is a high-impact opportunity to be a part of developing the product that will help nurses concentrate on what matters most- connecting with patients and delivering exceptional care. What You'll Do Develop and refine AI-driven nursing documentation tools using clinical expertise and collaborating with prompt engineers. Design experiments to assess and validate the accuracy of AI-generated nursing documentation and provide structured feedback. Build and refine evaluation tools to streamline nursing documentation quality assessment. Collaborate with cross-functional teams (ML researchers, data scientists, clinicians) to integrate nursing insights into AI models. Contribute to product development and broader business initiatives. What You'll Bring RN, or PhD with direct experience working in nursing practice Deep understanding of nursing documentation, nursing workflows, and nursing terminology Ability to evaluate AI-generated clinical notes using a data-driven approach, provide structured feedback, and guide improvements Hands-on experience in clinical data validation and quality assessment. Strong knowledge of healthcare data standards (e.g., FHIR, HL7) and privacy regulations (e.g., HIPAA) Experience collaborating with engineers and product teams to build AI-powered clinical tools Strong analytical and problem-solving skills Excellent written and verbal communication skills Bonus Points If... Experience in software engineering, particularly in prompt engineering or AI model development Previous experience in AI-powered clinical documentation tools or clinical decision support systems Published research in AI, machine learning, or healthcare technology Must be willing to work from our SF or NYC office at least 3x per week This position requires a commitment to a hybrid work model, with the expectation of coming into the office a minimum of (3) three times per week. Relocation assistance is available for candidates willing to move to San Francisco. We value people who want to learn new things, and we know that great team members might not perfectly match a job description. If you're interested in the role but aren't sure whether or not you're a good fit, we'd still like to hear from you. Why Work at Abridge? At Abridge, we're transforming healthcare delivery experiences with generative AI, enabling clinicians and patients to connect in deeper, more meaningful ways. Our mission is clear: to power deeper understanding in healthcare. We're driving real, lasting change, with millions of medical conversations processed each month. Joining Abridge means stepping into a fast-paced, high-growth startup where your contributions truly make a difference. Our culture requires extreme ownership-every employee has the ability to (and is expected to) make an impact on our customers and our business. Beyond individual impact, you will have the opportunity to work alongside a team of curious, high-achieving people in a supportive environment where success is shared, growth is constant, and feedback fuels progress. At Abridge, it's not just what we do-it's how we do it. Every decision is rooted in empathy, always prioritizing the needs of clinicians and patients. We're committed to supporting your growth, both professionally and personally. Whether it's flexible work hours, an inclusive culture, or ongoing learning opportunities, we are here to help you thrive and do the best work of your life. If you are ready to make a meaningful impact alongside passionate people who care deeply about what they do, Abridge is the place for you. How we take care of Abridgers: Generous Time Off: 14 paid holidays, flexible PTO for salaried employees, and accrued time off for hourly employees Comprehensive Health Plans: Medical, Dental, and Vision coverage for all full-time employees and their families. Generous HSA Contribution: If you choose a High Deductible Health Plan, Abridge makes monthly contributions to your HSA. Paid Parental Leave: Generous paid parental leave for all full-time employees. Family Forming Benefits: Resources and financial support to help you build your family. 401(k) Matching: Contribution matching to help invest in your future. Personal Device Allowance: Tax free funds for personal device usage. Pre-tax Benefits: Access to Flexible Spending Accounts (FSA) and Commuter Benefits. Lifestyle Wallet: Monthly contributions for fitness, professional development, coworking, and more. Mental Health Support: Dedicated access to therapy and coaching to help you reach your goals. Sabbatical Leave: Paid Sabbatical Leave after 5 years of employment. Compensation and Equity: Competitive compensation and equity grants for full time employees. ... and much more! Equal Opportunity Employer Abridge is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability. Staying safe - Protect yourself from recruitment fraud We are aware of individuals and entities fraudulently representing themselves as Abridge recruiters and/or hiring managers. Abridge will never ask for financial information or payment, or for personal information such as bank account number or social security number during the job application or interview process. Any emails from the Abridge recruiting team will come from *************** email address. You can learn more about how to protect yourself from these types of fraud by referring to this article. Please exercise caution and cease communications if something feels suspicious about your interactions.

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.

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.

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 Salary Range $65,000.00 - $100,000.00 USD The successful candidate is expected to work in one of our offices 3 days per week and also be available for travel as required. The annual base salary range posted represents a broad range of salaries around the U.S. and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training. 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

**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.

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

A Growing Homecare Company is currently seeking compassionate and experienced Field Nurses to do home visits for our patients in all boroughs of New York. Our goal is to provide superior, compassionate home care workers and healthcare services for elderly and disabled individuals in the comfort and dignity of their homes. We work closely with hospitals, physicians, and private caregivers for hire to develop and coordinate an individual plan of care while maintaining their independence at home. The Field Nurse is responsible for providing professional nursing care to patients requiring in-home care. Responsibilities Assess the patient/family situation for nursing and health-related problems. Educate the patient/family regarding the disease process, self-care techniques, and prevention strategies. Document on a timely basis, all nursing services provided to patients as well as periodic reports to coordinate care and remain in compliance with state/federal regulations. Instruct and supervise patients, caregivers, and home health aides in aspects of patient care as appropriate. Perform other related duties as assigned. Qualifications 1-2 years of experience in Certified Home Health Agency (CHHA) or Long-term care preferred. New York State RN License Strong Assessment and Clinical Skills Bilingual in Mandarin is preferred. Professional Liability Insurance Able to drive an automobile in good working order and available for use in the field. Compensation Initial assessment visit = $130.00 Reassessment visit = $100.00 Resumption of Care visit = $100.00 Supervisory visit = $80.00 **Per Diem and Full-time positions available.

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

Work Schedule - 7:30 am-4:00 pm M-F We need an RN that has at least 5 years' experience in **acute/critical care/transplant unit** and working in this field in the past year. The RN should have at least 1 of the following work history in their background: - **Acute/Critical care** experience (Not In a simulation lab) - **ER experience.** - **Organ donation/transplant experience** - Tissue/Blood banking - Critical care skill set. The chart review is critical, and the candidate must have knowledge of reviewing medical records for disease process, hanging blood and IV lines as well as critical care. **JOB SUMMARY:** - Responsible for maintaining compliance with FDA, AATB, international and state regulations during the second level quality review of all **tissue donor files** for tissue submitted to ensure the safety of **donated human tissue.** - Responsible for the triage and review of information received after initial donor release to assess the potential impact on donor suitability and distributed products, triggering escalation procedures and evaluation for regulatory action. **Education and Experience** **- NJ RN license from an accredited school of nursing** - Associates degree required, BSN or BS in Life Science preferred and five years of recent {within one year} experience as an RN on an **acute/critical care** unit, organ donation/transplant unit, in tissue/blood banking, utilization review and/or case management with critical care skill set knowledge preferred - CTBS Certified or willing to obtain within two years of employment **Essential Skills, Experience, and Competencies** Understanding & Recognizing (but not limited) the following: - physical assessment findings - history & physical reports - death summaries / autopsies - diagnostic values in Electronic Medical Records (EMRs) - progress notes - flow sheets - other EMRs - IV fluids & medications - abnormal vital signs **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, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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 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. This is a Memory Care Community. Schedule: The Wellness Nurse (LPN) is full-time (at least 30 hours per week) Shift: 7:00am - 3:00pm including every other weekend Salary Range: $33.00 - $36.00 Hourly 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.

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

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

A Growing Homecare Company is currently seeking compassionate and experienced Field Nurses to do home visits for our patients in all boroughs of New York. Our goal is to provide superior, compassionate home care workers and healthcare services for elderly and disabled individuals in the comfort and dignity of their homes. We work closely with hospitals, physicians, and private caregivers for hire to develop and coordinate an individual plan of care while maintaining their independence at home. The Field Nurse is responsible for providing professional nursing care to patients requiring in-home care. Responsibilities Assess the patient/family situation for nursing and health-related problems. Educate the patient/family regarding the disease process, self-care techniques, and prevention strategies. Document on a timely basis, all nursing services provided to patients as well as periodic reports to coordinate care and remain in compliance with state/federal regulations. Instruct and supervise patients, caregivers, and home health aides in aspects of patient care as appropriate. Perform other related duties as assigned. Qualifications 1-2 years of experience in Certified Home Health Agency (CHHA) or Long-term care preferred. New York State RN License Strong Assessment and Clinical Skills Bilingual in Mandarin is preferred. Professional Liability Insurance Able to drive an automobile in good working order and available for use in the field. Compensation Initial assessment visit = $130.00 Reassessment visit = $100.00 Resumption of Care visit = $100.00 Supervisory visit = $80.00 **Per Diem and Full-time positions available.

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 Range: $32/hr to $36/hr 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 Part-Time 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 (for Part-Time Employees): · Paid Time Off (PTO) and Holidays · Flexible Schedule · On the job training · Employee Assistance Program (EAP) · Free Parking 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.

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.