- Kaiser Permanente (San Diego, CA)
- …Graduate of accredited school of nursing. License, Certification, Registration Clinical Nurse Specialist Certificate (California) Registered Nurse ... in a Labor/ Management Partnership environment. Preferred Qualifications: Clinical Nurse Specialist experience preferred. Notes: This position supports Level… more
- Guidehealth (Rockford, IL)
- …comfortable and confident leading a team of certified but unlicensed personnel and Registered Nurse case managers Ability to read, analyze, and interpret the ... any concerns. Identifying and disseminating of Health Plan announcements applicable to Case Management Qualifications WHAT YOU'LL NEED TO HAVE RN /BSN required 5… more
- Baptist Memorial Health Care Corporation (Memphis, TN)
- Overview Specialist -Denial Mitigation II RN Job Code : 21432 FLSA Status Job Family : FINANCE Job Summary * Position may be filled in Memphis, TN; Jackson , MS ... The Denial Mitigation-Appeal Specialist II RN serves in a key...initial appeal action in order to optimize reimbursement and utilization of resources. Meticulously reviews extenuating circumstances and other… more
- Amazon (Doylestown, PA)
- …into favorable results for the company and employees. Required Qualifications: Be a Registered Nurse , Nurse Practitioner, or Licensed Professional Counselor ... advisory experience in occupational health, worker compensation, disability, health case management , or utilization review. 3+ years clinical work experience… more
- Regency Integrated Health Services (Austin, TX)
- …Care eligibility and benefit period through regular communications with Regional Care Management Specialist , Business Office and external Case Managers. Gathers ... in accordance with CMS Correction Policy and collaboration with Regional Care Management Specialist . Conducts regular audit of MDS process including validation… more
- AdventHealth (Hinsdale, IL)
- …documents avoidable days, and facilitates progression of care. *Collaborates with Utilization Management staff for collaboration on patient status changes ... KNOWLEDGE AND EXPERIENCE PREFERRED: *Current working knowledge of discharge planning, utilization management , care management , performance improvement and… more
- Franciscan Health (Munster, IN)
- …Knowledge Required : Basic Life Support Program (BLS) - American Heart Association Required: Registered Nurse ( RN ) - State Licensing Board Required : ... Degree in Nursing Preferred: Master's Degree in Nursing Education/Leadership/Clinical Nurse Specialist Preferred: 3years Nursing/Patient Care Preferred: 2… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Specialist + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Care ... 18, 2025 **Summary** **SUMMARY:** The System Utilization Management (SUM) Care Without Delay RN is...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- UnityPoint Health (Cedar Rapids, IA)
- …S + Shift: 40 Hours Per Week + Job ID: 168048 Overview The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments ... clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management ...degree in a health care related field or an RN + Two years of behavioral health work experience.… more
- Sanford Health (Bemidji, MN)
- …minimum of five years of clinical practice. Knowledge and experience in case management , utilization management and/or Coding highly preferred. Currently ... written/verbal communication, critical thinking, creative problem solving, and conflict management skills. Must be proficient in organization and planning....holds an unencumbered RN license with the State Board of Nursing where… more
- Commonwealth Care Alliance (Boston, MA)
- …responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
- LifePoint Health (Louisburg, NC)
- Registered Nurse ( RN ) Utilization Review Job...the lives of those we serve. Connect with our RN recruiting specialist . Do you need more time ... as an employee but as a person. As a registered nurse ( RN ) joining our...a valid job field* **Organization:** **Maria Parham Franklin* **Title:** * Registered Nurse Utilization Review Coordinator*… more
- AdventHealth (Orlando, FL)
- …601 EAST ROLLINS STREET, Orlando, 32803 **The role you'll contribute:** **The Care Transitions Registered Nurse ensures that a care plan is carried out in ... various other teams, including but not limited to Care Management nurses and social workers, nursing, home care liaisons,...State of Florida or multi state license as a Registered Nurse + Basic Life Support (BLS)… more
- Roper St. Francis (Charleston, SC)
- …received those credentials. **RCIS Licensure/Certification:** * Must maintain active Registered Cardiovascular Invasive Specialist Registration with the SC ... of Radiologic Technologists (AART). **RCIS Primary Source Verification:** * All - Registered Cardiovascular Invasive Specialist Registration with SC Board of… more
- LifePoint Health (Hickory, NC)
- * Registered Nurse ( RN ), Clinical Case Manager* PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment to ... valued as an employee, but as a person. As a* registered nurse ( RN )*joining our team,...level-of-care placement. * Uses EMR and MCG Criteria for utilization management and quality screening. * Identifies… more
- LifePoint Health (Johnstown, PA)
- …in employment. **Job:** **Nursing* **Organization:** ** **Title:** * Registered Nurse ( RN )- Case Management PRN/Hourly* **Location:** ... * Registered Nurse ( RN ), Case Manager...in the care of hospitalized patients. Our team of RN Case Managers, Social Workers, Utilization Review staff,… more
- AdventHealth (La Grange, IL)
- …resolution skills . Teamwork principles **EDUCATION AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse ( RN ) . ... documents avoidable days, and facilitates progression of care. . Collaborates with Utilization Management staff for collaboration on patient status changes and… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse - Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position ... of Microsoft Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted… more
- MyFlorida (Macclenny, FL)
- REGISTERED NURSE SPECIALIST -... utilization . Minimum Qualifications: + Licensure as a Registered Professional Nurse in accordance with Florida ... Requisition No: 857220 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST - 60043220...Ability to analyze complex reports and determine the service utilization habits of clients and to evaluate the appropriateness… more
