Nursing Jobs in Hanover, NJ
$85,000 - $106,300 / year
Overview Assesses member needs and identifies solutions that promote high quality and cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state and federal regulations. Delivers timely notification detailing clinical decisions. Coordinates with management, subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is appropriate, timely and cost effective. Works under general supervision. What We Provide Referral bonus opportunities Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability Employer-matched retirement saving funds Personal and financial wellness programs Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care Generous tuition reimbursement for qualifying degrees Opportunities for professional growth and career advancement Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities. What You Will Do Conducts comprehensive review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical providers, paraprofessional staff, caregivers and other relevant sources as necessary. Examines standards and criteria to ensure medical necessity and appropriateness of admissions, treatment, level of care and lengths of stay. Performs prior authorization and concurrent reviews to ensure extended treatment is medically necessary and being conducted in the right setting. Reviews requests for outpatient and inpatient admission; approves services or consults with medical directors when case does not meet medical necessity criteria. Ensures compliance with state and federal regulatory standards and VNS Health policies and procedures. Participates in case conferences with management. Identifies opportunities for alternative care options and contributes to the development of patient focused plan of care to facilitate a safe discharge and transition back into the community after hospitalization. Reviews covered and coordinated services in accordance with established plan benefits, application of evidenced based medical criteria, and regulatory requirements to ensure appropriate authorization of services and execution of the plan’s fiduciary responsibilities. Identifies and provides recommendations for improvement regarding department processes and procedures. Maintains current knowledge of organizational or state-wide trends that affect member eligibility and the need for issuance of Determination Notices Improves clinical and cost-effective outcomes such as reduction of hospital admissions and emergency department visits through on-going member education, care management and collaboration with IDT members. Provides input and recommendations for design and development of, processes and procedures for effective member case management, efficient department operations, and excellent customer service. Maintains accurate record of all care management. Maintains written progress notes and verbal communications according to program guidelines. Verifies that all aspects of the clinical record are in agreement with the member’s clinical and functional status. Utilizes VNS Health and state approved assessment and documentation as well as interviews with members, family, and care providers in decision-making. Performs annual clinical co-visits for nurses as well as two initial co-visits during the first six months for new hires as follows: one within first three weeks and a second within the first six months. Provides feedback to therapist and management; assists in development of plans to address improvement needs as appropriate. For Utilization Management Only: Issues Determinations, Notices of Action, and other forms of communication to members and providers which communicate VNS Health’s determinations. Ensures all records/logs related to decision requests, Notices of Action, and other communications required by state or federal regulations are saved in the Utilization Management System. Reviews, evaluates and determines the appropriateness of requests, utilize the most appropriate clinical care guidelines based on clinical practice guidelines. Adheres to all federal and regulatory requirements. Evaluates and analyzes care and utilization trends/issues and identifies opportunities for better coordination of members’ care. Qualifications Licenses and Certifications: Current license to practice as a Registered Professional Nurse in New York State required. Certified Case Manager preferred Education: Associate's Degree in Nursing required. Bachelor's Degree or Master’s degree in nursing preferred Work Experience: Minimum two years of experience with strong cost containment /case management background or two years acute inpatient hospital experience in chronic or complex care required Must have experience and qualifications demonstrating knowledge of working with the LTSS eligible population. preferred Knowledge of Medicare and Medicaid regulations required Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills. Working knowledge of Microsoft Excel, Power-Point, and Word and strong typing skills required Knowledge of Medicaid and/or Medicare regulations required Knowledge of Milliman criteria (MCG) preferred For UM Only: Experience must be with a Managed Care Organization or Health Plan. For SelectHealth ETE Only: Experience in Public Health programming, delivery and evaluation preferred Experience working with community-based organizations in underserved communities preferred Pay Range USD $85,000.00 - USD $106,300.00 /Yr. About Us VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day. 
$130,000 - $190,000 / year
Director of Nursing (DON) – Skilled Nursing Facility (SNF) Location: Elizabeth, New Jersey Job Type: Full-Time Position Summary We are seeking an experienced and compassionate Director of Nursing (DON) to lead and oversee all nursing operations at our Skilled Nursing Facility in Elizabeth, NJ. The Director of Nursing is responsible for ensuring the delivery of high-quality resident care, maintaining regulatory compliance, managing nursing staff, and fostering a culture of excellence and accountability. The ideal candidate is a strong clinical leader with a thorough understanding of long-term care regulations, staff development, quality improvement initiatives, and resident-centered care. Key Responsibilities Direct, supervise, and coordinate all nursing services within the facility. Ensure compliance with federal, state, and local regulations, including NJ Department of Health requirements. Develop and implement nursing policies, procedures, and standards of care. Recruit, train, mentor, and evaluate nursing staff, including RNs, LPNs, and CNAs. Oversee staffing schedules to ensure appropriate coverage and quality resident care. Monitor clinical outcomes and lead quality assurance and performance improvement (QAPI) initiatives. Collaborate with physicians, therapists, department heads, residents, and families to ensure comprehensive care planning. Manage infection prevention and control programs. Ensure accurate documentation and timely completion of clinical assessments. Participate in surveys, audits, and regulatory inspections. Maintain a positive work environment focused on teamwork, professionalism, and resident satisfaction. Qualifications Active and unrestricted Registered Nurse (RN) license in New Jersey. Minimum of 3–5 years of nursing leadership experience in a Skilled Nursing Facility, Long-Term Care, or Rehabilitation setting. Previous experience as a Director of Nursing, Assistant Director of Nursing (ADON), or equivalent leadership role preferred. Strong knowledge of CMS regulations, state survey processes, and long-term care operations. Demonstrated leadership, organizational, and communication skills. Ability to effectively manage staff, budgets, and clinical programs. CPR certification required. Benefits Competitive salary based on experience Health, Dental, and Vision Insurance Paid Time Off (PTO) Paid Holidays 401(k) with company match Professional development opportunities Supportive leadership team and collaborative work environment Why Join Us? Join a dedicated team committed to providing exceptional care and improving the quality of life for our residents. We offer an opportunity to make a meaningful impact while leading a skilled and compassionate nursing team. Apply today to become a valued member of our leadership team and help shape the future of resident care in Elizabeth, NJ. 
Salary $70+/hr Lasante Health Care is seeking a weekend Nurse Practitioner to provide medical services, focusing on health promotion, disease prevention, diagnosis, and treatment. The ideal candidate will excel in these areas, supporting our mission to deliver quality healthcare to our community. Responsibilities: - Prescribe medication, examine patients, and provide treatment - Gather health histories - Order, interpret, and evaluate diagnostic tests - Perform physical examinations - Develop and implement treatment plans - Dictate and document all patient interactions - Notify managing physician about unusual or unexpected events or problems Qualifications: - Current license/registration to practice - Excellent verbal and written communication skills - Ability to maintain highly confidential information - Warm, comforting demeanor - Availability Friday night Saturday night and Sundays 
