Senior RN Appeals & Utilization Analyst
Horizon Blue Cross Blue Shield of New Jersey - Headquarters
Horizon Blue Cross Blue Shield of New Jersey is seeking a skilled Utilization Management RN to handle medical appeal cases, ensure timely processing, and maintain regulatory compliance (NCQA, URAC, NJ/Federal). The role includes mentoring staff, coordinating with legal, and supporting 24/7 on-call appeal coverage. Qualifications include RN license, 2 years clinical experience, and 3 years in healthcare delivery. Bachelor’s in healthcare mgmt preferred or equivalent experience. #J-18808-Ljbffr Horizon Blue Cross Blue Shield of New Jersey
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Senior RN Appeals & Utilization Analyst in Hopewell, NJ vacancy
$79.1k - $105.95k
...About the Role This position is responsible for handling all Utilization Management medical appeal cases. Ensures that timeliness guidelines are met and... ...projects as assigned by management. Appeals Resolution RN's are required to work a specified number of weekends and...SuggestedLive inLocal areaRemote workWeekend work- ...reagents and supplies for the laboratory. Participate in internal and external GMP audits, as needed. Train other junior level analysts and new hires on CE instrumentation, GMP practices, and data analysis. Serving as subject matter expert in one or more areas of...SeniorWork experience placement
BeOne Medicines
Pennington, NJ1 day ago $90.9k - $125.9k
...reagents and supplies for the laboratory. Participate in internal and external GMP audits, as needed. Train other junior level analysts and new hires on CE instrumentation, GMP practices, and data analysis. Serving as subject matter expert in one or more areas of...SeniorHourly payWork experience placementLocal areaBeiGene
Hopewell, NJ5 days ago- ...descriptive and predictive audience segmentation. We are seeking a Data Analyst with a versatile skill set to undertake data science and... ...of MRM with questions they have on the system and processes utilized in the tool. Collaborate with stakeholders to discuss requirements...SeniorInternshipLocal areaRemote work
Acxiom
Trenton, NJ5 days ago $55.68k
...FirstEnergy at a Glance We are a forward-thinking electric utility powered by a diverse team of employees committed to making customers... ...Finance, and projects are in-serviced in a timely manner. Analysts will work closely with 5-6 Project Managers in preparation of 2...SeniorContract workWork experience placementH1bWork at officeJersey Central Power & Light
Trenton, NJ1 day ago$92,289.6 - $120,577.6 per week
...development, and submission of inpatient and outpatient clinical appeals for denied hospital claims. This role applies clinical... ...Three years' clinical nursing experience required. Experience in utilization review, case management, clinical appeals, CDI, or denial management...Full timeTemporary workPart timeWork at officeFlexible hoursCapital Health (US)
Lawrence Township, NJ1 day ago- ...techniques.You are excellent in Data Visualization.You are good in using Cognos and Business Objects.You will be reporting to the Senior Consultant.About our client: They are an equal opportunity employer and with value diversity at their company. They do not discriminate...Senior
- Assist with pricing reinsurance contracts across Casualty, Specialty and other classes Conduct profitability studies in various segments of the portfolio Maintain and update pricing models, pricing parameters, and data tables supporting underwriting divisions rating algorithms...SeniorVisa sponsorshipWork visaFlexible hours
Jobtailor
Pennington, NJ3 days ago - Horizon Blue Cross Blue Shield of New Jersey seeks an experienced Actuary to support the actuarial bid pricing process for Medicare Advantage lines. The role involves conducting profitability analysis, forecasting, and reporting to stakeholders. The ideal candidate will...Senior
- ...Consulting Analyst / Senior Analyst Long-term consulting opportunity! Jump right into a growing organization in this Analyst / Senior Analyst role. 4+ years of cash forecasting, cash management, funding and reporting desired. Responsibilities: Assume a key...Senior
KNM Resources
Neshanic Station, NJ2 days ago $185.8k - $242k
...Future focused and always one step ahead! At Munich Re, we utilize extensive risk knowledge to offer expertise, financial strength... ...internal economic capital model and scenario analyses. We provide senior management with an internal view of our companies’ risk profile...SeniorTemporary workPrinceton, NJa month ago- Job Description:Senior Analyst, Marketing Data OperationsLocation: Princeton Union Role - YesJob Description: The Marketing Operations team is seeking a business intelligence analyst to build, execute and support campaign analytics across multiple lines of businesses....SeniorFull timeWork at officeLocal areaFlexible hours
$105k - $130k
...Senior Analyst, Life Sciences Consulting Company: Dedham Group Location: Remote, United States Date Posted: Apr 10, 2026 Employment Type: Full Time Job ID: R-410 Description About Us The Dedham Group has set out to develop a health care innovation...SeniorFull timeTemporary workLocal areaRemote workFlexible hoursShift workNorstella
Trenton, NJ1 day ago$126.8k - $244k
...resilience, simplification, and a bold reinvention of product and services, operating models, and workforce capabilities. As a Senior BCM Analyst at EY, you will be an expert on key banking topics, contributing to EY's distinctive perspective on client issues within the...SeniorSummer holidayLocal areaFlexible hoursEY
Trenton, NJ2 days ago$127.4k - $172.4k
BeOne Medicines, based in Hopewell, New Jersey, seeks an experienced professional to manage QC Microbiology and lead Environmental Monitoring programs. The role involves overseeing microbiological testing, ensuring compliance with FDA/EU regulations, and mentoring a high...Senior- Johnson & Johnson Innovative Medicine seeks a Transcend Deploy Sr Analyst to lead the global deployment of Quality Management capabilities using SAP S/4HANA. You will coordinate with NextGen QS and satellite systems, ensuring end-to-end release, testing, and regulatory...Senior
$105.4k - $207.8k
...across assessment, design, implementation, and ongoing optimization. Recruiting for this role ends on 12/31/2026. Work you'll do As a Senior Engineering Management Specialist on the Cyber team, you will be responsible for… Assessing client data governance and compliance...SeniorLocal areaVisa sponsorship- Integra LifeSciences in the United States seeks a Medical Device Complaint Trending Expert responsible for end-to-end development and oversight of complaint data trending, signal detection, and post-market surveillance. You will act as SME for analytics, methods, and regulatory...Senior
- ...Senior Business Analyst vTech can help you avoid the daunting task of writing and posting job offers, shifting through resumes and laboring through the lengthy interview process. Our Staffing solutions will allow you to elude those tasks and place topnotch, high-caliber...SeniorShift work
vTech Solution
Trenton, NJ2 days ago - ...Munich Re Specialty - North America is seeking an Actuarial Analyst Sr for Insurtech Programs to provide pricing and rating support for the MRS-NA Insurtech Programs. The role involves analyzing, modeling and rating potential solutions, plus supporting rate filings across...Senior
Munich Reinsurance America, Inc.
Princeton, NJ3 days ago $92.5k - $131.7k
...the biggest impact because: Together We Have the Power to Win.Job SummaryChurch & Dwight is seeking a Sr. IT Supply Chain Functional Analyst to join our Global Supply Chain Technology team. This role is responsible for partnering with business stakeholders to translate...SeniorFull timeLocal areaRemote work$95k - $110k
...United States Suitability/Public Trust Fully remote Information Technology Overview GovCIO is seeking Senior Project Analyst to support a large, complex federal program. In this role, you will lead contractual deliverable tracking, oversee award fee self...SeniorFull timeContract workWork at officeRemote workFlexible hoursGovCIO
Trenton, NJ1 day ago- ...potential pricing change impact on customer’s book of business. · Compiles and maintains relevant competitive and pricing data utilizing external sources and internal systems. · Maintains price Mailbox · Updates Contract Master File upon completion of customer agreements...SeniorContract workWork experience placementWork at officeLocal area
$130k - $135k
...encourage you to apply and join our team. About the Role Our Security Operations Center (SOC) is expanding, and we’re seeking a Senior SOC Analyst to support a weekend schedule ( Wednesday – Sunday OR Saturday – Wednesday from 8:00 AM to 5:00 PM CT ) who can quickly...SeniorFull timeRemote workShift workWeekend workWorld Wide Technology
Trenton, NJ2 days ago- ...Revenue Integrity Analyst The Revenue Integrity Analyst (RIA), reporting directly to... ...coordinate and manage RAC and payer audit appeals. Identifies barriers and implements... ...Contacts. Creates monthly Excel Payer logs utilizing several spreadsheets and consolidating them...Contract work
Hunterdon Health
Flemington, NJ5 days ago - Department: SciMax Platform Services - Product Management No. of Vacancies 1 Specific Skills Strong business analysis, requirements elicitation, and documentation skills. Good understanding of SDLC, Agile, and Waterfall methodologies. Experience with requirements management...SeniorPermanent employmentFull time
- Position Overview We are seeking an experienced Business Analyst with Treasury domain expertise to join our team for an immediate onsite engagement. The ideal candidate will possess strong Agile delivery experience, exceptional communication skills, and a proven ability...SeniorImmediate start
- ...A leading insurance company is seeking a Senior Actuarial Analyst in Trenton, New Jersey. This role involves developing and supporting a pricing framework and leading projects while mentoring entry-level analysts. Candidates should have over 4 years in actuarial roles...SeniorRemote work
Ally
Ewing, NJ3 days ago $91.1k - $179.5k
...and operational services to enable heart-of-the-business solutions.Recruiting for this role ends on 09/24/2026.Work you'll do As a Senior Consultant, Functional Transformation on the SAP business transformation services team, you will be responsible for: Support end-to...SeniorLocal area$64.89k - $158.62k
We’re building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize...SeniorHourly payFull timeTemporary workWork experience placementLocal area
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Senior RN Appeals & Utilization Analyst. Be the first to apply!
