Nursing Jobs in Pittsgrove, NJ
$83,200 - $128,960 / year
Department/Unit: HBD - Surgery Bariatric Work Shift: Day (United States of America) Salary Range: $83,200.00 - $128,960.00 RN - Full Time Bariatric Program Albany, NY The Registered Professional Nurse in the ambulatory setting provides care across the life span to individuals, families, caregivers, groups, populations, and communities. This is accomplished during face-to-face encounters or through a variety of telecommunication strategies, often resulting in the establishment of long-term patient care relationships. During each encounter, the registered nurse focuses on patient safety and the quality of nursing care by applying appropriate nursing interventions, such as identifying and clarifying patient needs, performing procedures, conducting health education, promoting patient advocacy, coordinating nursing and other health services, assisting the patient to navigate the health care system, and evaluating patient outcomes. Ambulatory care registered nurses, acting as partners and advisers within the interdisciplinary team, assist and support patients and families to optimally manage their health care, respecting their culture and values, individual needs, health goals and treatment preferences. Essential Duties and Responsibilities include: Obtains and accurately record patient’s vital signs; reports abnormal values to treating provider Obtains and documents a patient’s history (Medical, Surgical and Social) and focused physical assessment, related to the clinic visit and as dictated by clinic procedure Administers medications and treatments to patients in clinic, under the direction of a physician or APP Participates in in-office procedure, as related to clinic specialty, under the direction and supervision of a Physician or APP and documents results in EHR Performs review and triage of incoming test results, patient requests and pharmacy renewals; facilitates call-backs to patients as necessary Facilitates the utilization of resources to meet patient outcomes and contribute to Facility (AMC), New York State and National Quality data metrics Delegates tasks deemed appropriate per licensure of LPN and/or MA Adheres to AMC’s regulatory agency (The Joint Commission) and internal compliance policies Orientation and education of newly hired staff Completes continuous/annual education related to Clinic specialty to maintain knowledge base on current practices Provides education to patients related to their visit and overall health and wellness Excellent customer service and communication skills Ability to effectively present information and respond to questions from physicians, patients and their family members or other employees within the work setting. Familiar with computer software. Effective Written and Verbal Communication Skills Ability to give medications via all routes and ability to calculate medication doses Minimum Qualifications: Associate’s degree of a state accredited Registered Nursing program is required NYS current RN licensure to practice professional nursing is required Current CPR certification required Certification in specialty, Ambulatory setting preferred Working Knowledge of MS Word and Excel Experience with electronic health record preferred Thank you for your interest in Albany Med Health System! Albany Med Health System is an equal opportunity employer. This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification. 
$75,000 - $115,000 / hour
Case Manager – HMO Skilled Nursing Focus Location: Eddystone, Pennsylvania Salary Range: $75,000 – $115,000 annually Position Summary We are seeking an experienced and detail-oriented Case Manager to support members within a Skilled Nursing Facility (SNF) and managed care/HMO environment. This role is responsible for coordinating patient care services, managing utilization review activities, and serving as a liaison between providers, facilities, and insurance payers to secure timely authorizations and reimbursement. The ideal candidate will have strong knowledge of post-acute care, utilization management, insurance authorization processes, appeals and denial management, and interdisciplinary care coordination. Candidates may hold credentials as an LPN, RN, Master Social Worker (MSW), or Licensed Social Worker (LSW/LCSW), depending on state requirements and organizational needs. Key Responsibilities Manage and coordinate care for members/residents in skilled nursing and post-acute care settings. Perform utilization management and concurrent review to ensure appropriate level of care and length of stay. Obtain and track insurance authorizations for admissions, continued stays, therapies, specialty services, and transitions of care. Communicate with HMOs, Medicare Advantage plans, commercial insurers, and other payers regarding clinical updates and authorization requirements. Prepare, submit, and monitor appeals for denied or reduced services, including writing clinical justifications and gathering supporting documentation. Review denial trends and collaborate with facility leadership to improve reimbursement outcomes and reduce avoidable denials. Coordinate interdisciplinary care planning with nursing, therapy, social services, physicians, and discharge planning teams. Facilitate safe and timely transitions of care, including discharge planning and community resource coordination. Maintain accurate and timely documentation in accordance with regulatory, payer, and organizational requirements. Ensure compliance with Medicare, Medicaid, managed care, and facility policies and procedures. Educate residents, families, and staff regarding insurance coverage, benefits, care planning, and discharge options. Participate in quality improvement initiatives related to utilization review, readmission reduction, and payer performance metrics. Qualifications Required Current and active licensure/certification in one of the following: Licensed Practical Nurse (LPN) Registered Nurse (RN) Master Social Worker (MSW) Licensed Social Worker (LSW/LCSW), depending on state requirements Minimum of 2 years of experience in case management, utilization review, managed care, skilled nursing, or post-acute care. Experience working with Medicare, Medicaid, Medicare Advantage, and commercial insurance plans. Strong understanding of authorization processes, payer guidelines, appeals, and denial management. Excellent communication, organizational, and documentation skills. Ability to manage multiple cases and deadlines in a fast-paced healthcare environment. Preferred Certification in Case Management (CCM, ACM, or equivalent). Experience in SNF reimbursement and PDPM. Familiarity with electronic medical records (EMR/EHR) systems. Knowledge of state and federal regulatory requirements for skilled nursing facilities. Skills & Competencies Utilization Management Insurance Authorization & Verification Appeals & Denial Resolution Care Coordination Discharge Planning Managed Care/HMO Processes Clinical Documentation Review Interdisciplinary Collaboration Critical Thinking & Problem Solving Time Management & Organization Work Environment Skilled Nursing Facility (SNF), post-acute care, managed care organization, or hybrid setting. May require communication with external insurance representatives, hospitals, providers, and family members throughout the day. Equal Opportunity Statement We are an equal opportunity employer and is committed to creating an inclusive environment for all employees. INDCONF3 
