- Humana (Columbus, OH)
- …help us put health first** Humana Healthy Horizons in Virginia is seeking a Manager , Utilization Management (Behavioral Health) who will utilize their ... communication of behavioral health services and/or benefit administration determinations. The Manager , Utilization Management (Behavioral Health) applies a… more
- Prime Therapeutics (Columbus, OH)
- …and drives every decision we make. **Job Posting Title** Senior Project Solution Manager ( Utilization Management ) - Remote **Job Description Summary** ... Responsible for the management of a variety of projects for corporate and/or...+ For clinical related roles, clinical licensure (eg, LPN, RN , LCSW, LMSW) is preferred. + 7+ years of… more
- CVS Health (Richmond, VA)
- …and affordable. Position Summary The manager of Clinical Health Services Utilization Management will develop, implement, support, and promote Health Services ... Required Qualifications + Must have active, current and unrestricted RN licensure state of residence + Must have compact...years in clinical area of expertise. + 3+ years Utilization Management experience + MS Office Suites… more
- UCLA Health (Los Angeles, CA)
- …the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management ... a self-motivated, detail-oriented, service-driven leader with: + Current unrestricted RN licensure in CA required + Bachelors of Science,...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- Medical Mutual of Ohio (OH)
- …team members and operations of assigned commercial and government clinical care utilization management area. Evaluates team resources and production data and ... line of business (Commercial, Medicare, Medicaid) required. **Professional Certification(s):** + Registered Nurse with current unrestricted State of Ohio or… more
- Elevance Health (Washington, DC)
- …degrees of medical complexity and acuity. Participates in case and/or utilization management execution/decision making for managed member populations. Primary ... in the development, implementation, and coordination of a comprehensive integrated Medical Management program designed to manage health outcomes in a highly complex… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Manager Utilization Management Nursing utilizes clinical nursing skills to support ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …years of progressively responsible and directly related work experience License/Certification: CA Registered Nurse ( RN ) Knowledge, Skills, & Abilities These ... include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness… more
- Universal Health Services (Dearborn, MI)
- Responsibilities Utilization Management Case Manager Beaumont Behavioral Health (a UHS Facility) A growing 144-bed behavioral health facility - Beaumont ... more information, please visit our website: https://beaumontbh.com/ PositionSummary The Utilization Management Case Manager is...degree in social work, counseling or a Michigan licensed Registered Nurse is required. + Full licensure… more
- Trinity Health (Fresno, CA)
- …Care seeking your next adventure?** **Duration:** 13-week Assignment The Interim Utilization Management , RN Manager is responsible for management , ... of Saint Agnes Medical Center. The RN Manager of Utilization Management will...families, and hospital staff **Requirements** + State of California Registered Nurse ( RN ) License. +… more
- UNC Health Care (Chapel Hill, NC)
- …whose mission is to improve the health and well-being of the unique communities we serve. RN Utilization Manager position specifically for a Utilization ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to… more
- Centene Corporation (OK)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... review clinicians to ensure appropriate care to members. Manages BH utilization management issues related to member care, provider interactions, and facilitates… more
- Mountains Community Hospital (Lake Arrowhead, CA)
- Full Time - Exempt position SUMMARY The Case Manager is responsible for utilization management and case management of patient admissions at MCH by ... working knowledge of state and federal regulations. EDUCATION/EXPERIENCE Current California Registered Nurse License Five years nursing experience required… more
- AmeriHealth Caritas (Newark, DE)
- ** Utilization Management Plan Oversight Manager , Registered Nurse (must reside in DE)** Location: Newark, DE Primary Job Function: Medical ... and serves as SME for clinical components DE Medicaid Utilization Management Program. Works in close collaboration... RN license in Delaware. + 3+ years utilization / case management experience in relevant… more
- Sharp HealthCare (San Diego, CA)
- …Associate's Degree in Nursing; Accredited Case Manager (ACM) - American Case Management Association (ACMA); California Registered Nurse ( RN ) - ... Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized...clinical experience as defined by the CBA + California Registered Nurse ( RN ) - CA… more
- Dignity Health (Rancho Cordova, CA)
- …home.** **Position Summary:** Under the guidance and supervision of the department Manager /Director, the Supervisor of Utilization Management is responsible ... Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management...accredited school of nursing. - Clear and current CA Registered Nurse ( RN ) license. **Preferred… more
- Trinity Health (Ann Arbor, MI)
- …a variety of backgrounds because diversity makes us stronger. The RN Registered Nurse Case Manager assumes overall accountability for patients' discharge ... expertise or equivalent experience and expertise as a Case Manager . + Certification: Case Management is desirable.... manager . **ESSENTIAL FUNCTIONS AND RESPONSIBILITIES** + The RN Registered Nurse Case … more
- Avera Marshall (Sioux Falls, SD)
- …your lifestyle and opportunities for career growth. Avera is looking for a Registered Nurse ( RN ) - Case Manager to join our Team! Position Highlights: + ... care. Job Summary + The RN Case Manager is a specialized nurse that identifies...case management and/or service coordination. + The RN Case Manager develops and facilitates the… more
- Glens Falls Hospital (Glens Falls, NY)
- …30 hours per week, can be foundhere. **Job:** **Nursing - Case Management * **Title:** * Registered Nurse - Utilization Review Nurse - Care ... accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing..., or payer experience preferred. *Licenses, Certifications, Registrations:* * Registered Nurse ( RN ) in New… more
- LA Care Health Plan (Los Angeles, CA)
- …Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse ( RN ); current and unrestrited California License. ... Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The… more