Top 56 Utilization review Jobs in Flemington Nj

RN I- Utilization Management
Horizon Blue Cross Blue Shield of New Jersey —Hopewell, NJ
- $70,500 - $94,395 a year
- Weekends as needed
- Nursing
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
12d
RN I
Horizon Blue Cross Blue Shield of New Jersey —Hopewell, NJ
- $70,500 - $94,395 a year
- Weekends as needed
- Nursing
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
12d
Utilization Review RN Per Diem
Saint Peter's University Healthcare System —New Brunswick, NJ
- $51 an hour
- Full-time
- Nursing
- RN License
- 5 years
- Free parking
- Health insurance
Quick Apply
7d
Review Coordinator
National Medical Reviews —Warminster, PA
- $65,000 - $70,000 a year
- Full-time
- Mid-level
- Ability to sit for extended periods
- Recruiting
Quick Apply
RN II, Primary Nurse Care (Case Manager-REMOTE)
Horizon Blue Cross Blue Shield of New Jersey —Hopewell, NJ
- $79,100 - $105,945 a year
- Full-time
- Remote
- Bilingual
- Nursing
- Microsoft Excel
- Health insurance
- Dental insurance
Utilization Management Coordinator
Rutgers University —Piscataway, NJ
- $71,162 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Dental insurance
Documentation Review Nurse
Hunterdon Health —Flemington, NJ
- $93,077.77 - $116,347.21 a year
- Full-time
- Nursing
- RN License
- Bachelor of Science
- Health insurance
- Dental insurance
Quick Apply
RN II - Oncology Case Manager-REMOTE BASED
Horizon Blue Cross Blue Shield of New Jersey —Hopewell, NJ
- $79,100 - $105,945 a year
- Weekends as needed
- Remote
- Nursing
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
RN II (Field Based - Somerset County)
Horizon Blue Cross Blue Shield of New Jersey —Hopewell, NJ
- $79,100 - $105,945 a year
- Full-time
- Bilingual
- RN License
- Mid-level
- Health insurance
- Dental insurance
RN II (Field Based - Hudson County)
Horizon Blue Cross Blue Shield of New Jersey —Hopewell, NJ
- $79,100 - $105,945 a year
- Full-time
- Bilingual
- RN License
- Mid-level
- Health insurance
- Dental insurance
Manager Utilization Review - FT - Day - Utilization Resource Mgmt Trenton NJ
Capital Health —Trenton, NJ
- $97,947.20 - $127,982.40 a year
- 8 hour shift
- Nursing
- RN License
- Bachelor of Science
- AD&D insurance
- Disability insurance
Admissions Coordinator
SERV Behavioral Health System —Township of Hamilton, NJ
- $68,626.97 a year
- Full-time
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
Quick Apply
RN II, -Oncology Case Manager-REMOTE
Horizon Blue Cross Blue Shield of New Jersey —Hopewell, NJ
- $79,100 - $105,945 a year
- Full-time
- Remote
- Bilingual
- Nursing
- Microsoft Excel
- Health insurance
- Dental insurance
Clinical Denials Utilization Review RN - FT - Day - Utilization Resource Management Pennington NJ
Capital Health —Trenton, NJ
- $86,964.80 - $113,672.00 a year
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
- AD&D insurance
- Disability insurance
Clinical Appeals RN - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ
Capital Health —Princeton, NJ
- $92,289.60 - $120,577.60 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- AD&D insurance
- Disability insurance
RN Care Manager – Program Evaluation (MED-25-00002)
Catholic Charities - Diocese of Trenton —Trenton, NJ
- $80,000 a year
- Full-time
- Bilingual
- Background check
- CPR Certification
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse - House Supervisor
Prosperity Workforce Solutions —Belle Mead, NJ
- $96,000 - $105,000 a year
- 12 hour shift
- Nursing
- RN License
- Mid-level
- Health insurance
Quick Apply
Counselor - Gateway Partial Care (5846)
Center for Family Services —Washington, NJ
- $25 an hour
- Part-time
- Nursing
- Psychiatry
- Bachelor of Science
- Flexible spending account
- Opportunities for advancement
Chief Financial Officer
SERV Behavioral Health System —Township of Hamilton, NJ
- $230,000 - $240,000 a year
- Weekends as needed
- CPA
- 5 years
- Bachelor of Science
- Relocation assistance
Quick Apply
Social Worker / Case Manager
RHA Health Services —Pipersville, PA
- $21 - $25 an hour
- Full-time
- 18 years or older
- Mid-level
- Master's degree
- Health insurance
- Paid time off

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RN I- Utilization Management

Horizon Blue Cross Blue Shield of New Jersey -
Hopewell, NJ

Apply Now

Job Details

Full-time
$70,500 - $94,395 a year
12 days ago

Benefits

Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Vision insurance
Volunteer time off
Retirement plan

Qualifications

RN License
Task prioritization

Full Job Description

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

About the Role

This 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.

The role supports M-F workweek coverage for team. Mandatory weekends / holidays throughout the year.

What You'll Do

Responsibilities:

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.
Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided.
Coordinates and assists in implementation of plan for members.
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.
Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.
Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
Encourages member participation and compliance in the case/disease management program efforts.
Documents accurately and comprehensively based on the standards of practice and current organization policies.
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.
Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.
Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
Completes other assigned functions as requested by management.

What You Bring

Education/Experience:

Requires an associate-s or bachelor-s degree (or higher) in nursing and/or a health related field OR accredited diploma nursing school.
Requires a minimum of two (2) years clinical experience.

Utilization Management Only

RN’s are required to work a specified number of weekends and holidays to meet Regulatory and Accrediting body standards. Requirements may vary based on department’s business needs.

Additional licensing, certifications, registrations:

Active Unrestricted NJ RN License Required

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 Outlook) 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

This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!

Salary Range:

$70,500 - $94,395

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement

Disclaimer:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

Apply Now

Refine Your Search

utilization review jobs in flemington nj

RN I- Utilization Management

RN I

Utilization Review RN Per Diem

Review Coordinator

RN II, Primary Nurse Care (Case Manager-REMOTE)

Utilization Management Coordinator

Documentation Review Nurse

RN II - Oncology Case Manager-REMOTE BASED

RN II (Field Based - Somerset County)

RN II (Field Based - Hudson County)

Manager Utilization Review - FT - Day - Utilization Resource Mgmt Trenton NJ

Admissions Coordinator

RN II, -Oncology Case Manager-REMOTE

Clinical Denials Utilization Review RN - FT - Day - Utilization Resource Management Pennington NJ

Clinical Appeals RN - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ

RN Care Manager – Program Evaluation (MED-25-00002)

Registered Nurse - House Supervisor

Counselor - Gateway Partial Care (5846)

Chief Financial Officer

Social Worker / Case Manager

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