- AltaMed Health Services Corporation (Montebello, CA)
- …day. Job Overview The LVN Utilization Management Nurse (UM Nurse ) will provide routine review of authorization requests from all lines of business ... Vocational Nurse . Minimum of 2 years of managed care experience in Utilization Management /prior authorization required. A minimum requirement of a valid BLS… more
- TrackFive (New York, NY)
- …to $2,900 per weekAbout The PositionJob Opportunity: Registered Nurse (Case Management - Utilization Review ) Bronx, NY 10457 Duration: 13 ... Experience Prior critical care experience Knowledge of CarePort, MCG, and/or InterQual Utilization Review e.xperience a plus About Lancesoft IncEstablished in… more
- Sonder Health Plans, Inc. (Atlanta, GA)
- …we'd love for you to join us. Sonder Health Plans is looking for a full-time Utilization Management Nurse to make sure our health services are administered ... working in a managed care environment with Medicare Advantage/Commercial populations, utilization management experience and acute clinical nursing experience… more
- TrackFive (Cambridge, MA)
- …MA is seeking its next amazing RN (Registered Nurse ) to work in Case Management ( Utilization Review ). Read on if this sounds like your perfect fit! ... and adding your skill and talent to our Travel Nurse workforce. Hit the road with Medical Solutions and...on assignment with one of the nation’s top travel nurse companies. Our awesome Recruiters realize the importance of… more
- TrackFive (Atlanta, GA)
- …3 days of RTOWellstar does not allow block schedulingJob Summary: The RN Clinical Nurse is a proactive member of an interdisciplinary team of licensed and unlicensed ... patient care. They practice in a clinical environment that is administered by Nurse Managers and other leaders and is supported through the Wellstar Shared… more
- UnitedHealth Group (Seattle, WA)
- …certification 3+ years of experience working in acute care 1+ years of care management , utilization review or discharge planning experience HMO experience ... Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization reports and systems such as Health… more
- TrackFive (Johnson City, NY)
- …City, New York, 13790!Pay Information$2,669 per weekAbout The PositionJob Title: Registered Nurse Profession: Nurse Specialty: Staff Duration: 13 weeks Shift: ... milrinone, heparin, insulin). Experience with anticoagulants. Description: The Registered Nurse protects, promotes, and optimizes health and abilities. The RN… more
- TrackFive (San Diego, CA)
- …Health* Hospice* Insurance Company* Long Term Acute Care/Rehab/Skilled Nursing* Case Management / Utilization Review Admission Criteria Benefits Eligibility ... Abstraction* Determine Medical Necessity per Evidence-Based Guidelines* Disability case management * Discharge Planning Disease management * Needs Assessment/… more
- TrackFive (Miami, FL)
- …need to know and understand the medical needs for patients Certification in Case Management , Nursing or Utilization Review is preferred Florida RN license ... (ie, physical, psycho-social, financial). Participates in IDT rounds, Conducts utilization review , evaluates clinical information, and communicates findings… more
- Ochsner Health (Gretna, LA)
- …home health, managed care, care management , case management or utilization review .CertificationsRequired - Current registered nurse (RN) license in ... to change at the company's discretion. EducationRequired - Registered nurse diploma.Preferred - Associate or bachelor's degree in nursing.Work ExperienceRequired… more
- TrackFive (Melrose, MA)
- …patient and family members and community resources to facilitate the utilization management review /discharge planning processLocal candidates accepted. ... 5 days/week 8-4:30p general hours. This is RN Case management , no utilization review responsibilities....quality patient care. With our comprehensive allied professionals and nurse staffing services, we provide you access to a… more
- TrackFive (Aurora, CO)
- …(CoPs), ORYX Core Measures, and accreditation bodies (TJC & HFAP) preferred. Case Management experience including utilization review and discharge planning ... and quality compliance with governmental/regulatory rules and regulations. Coordinates management action plans for accreditation - ongoing / continual readiness… more
- TrackFive (Hanford, CA)
- …discharge planning - Required Experience with all patient populations - Required Case Management or Utilization Review Certification - Highly Preferred ... Manager RN in Hanford, California, 93230!About The PositionSpecialty: RN Case Management Job Details: Responsible for coordinating medical care, and matching patient… more
- TrackFive (Springfield, MA)
- …BSN, current Massachusetts RN license, 3 years of prior hospital Case Management plus Utilization Review experience required.About Patterns LLCPatterns ... healthcare team, the Case Manager is accountable for coordinating and facilitating the management of care for an assigned group of patients. The Case Manager ensures… more
- TrackFive (San Diego, CA)
- …Care Case Management /Discharge Planning) Work Settings Acute Hospital Case Management / Utilization Review Admission Criteria Benefits Eligibility Care ... coordination Discharge Planning Disease management Needs Assessment/ Order DME Plan of Care Prior Authorizations Regulatory BenefitsMedical & Health Insurance… more
- TrackFive (Las Cruces, NM)
- …improvement activities. Reports findings to other departments such as utilization review , infection control, and risk management . Serves as a working member ... deep knowledge of the healthcare sector’s unique demands.Whether you are a nurse , physician, therapist, or allied health professional, Pacer Staffing is committed to… more
- AmeriHealth Caritas Health Plan (Wilmington, DE)
- Role Overview Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and ... occasional overtime, and weekends based on business needs Responsibilities Conduct utilization management reviews by assessing medical necessity, appropriateness… more
- CenCal Health (Santa Barbara, CA)
- …Central Coast Salary Range: $84,877 - $123,072 Annually Job Summary The Health Plan Nurse Coordinator - Adult Utilization Management (HPNC - Adult UM) ... is a Registered Nurse assigned to the Utilization Management unit. This position reports to...of medical management activities. Understanding of basic utilization review principles and practices. Education and… more
- University Health (San Antonio, TX)
- …years of recent, full-time hospital experience preferred. Work experience in case management , utilization review , or hospital quality assurance experience ... preferred. LICENSURE/CERTIFICATION A current license from the Board of Nurse Examiners of the State of Texas to practice...the State of Texas to practice as a registered nurse is required. National certification in a related field… more
- Integrated Home (Hollywood, FL)
- …and reward programs Comprehensive paid training program What will you be doing: As a Utilization Management Nurse , you will ensure that home health care ... By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won't...others in any situation Provide updates to Manager of Utilization Management for review What… more
