- Henry Ford Health System (Troy, MI)
- …screening criteria and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical ... Management experience in lieu of bachelor's degree. CERTIFICATIONS/LICENSURES REQUIRED: + Registered Nurse with a valid, unrestricted State of Michigan License.… more
- BAYADA Home Health Care (Orlando, FL)
- …with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote , Home Health Coding, Coder, ... immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work...Manager with OASIS and Coding certification to work remotely. RN , PT, OT, and SLP's with certifications will be… more
- Ochsner Health (New Orleans, LA)
- …case management or utilization review . **Certifications** Required - Current registered nurse license in state of practice. Basic Life Support (BLS) from ... and implement discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- Community Health Network (Indianapolis, IN)
- Registered Nurse ( RN ) Case Manager - North Job Ref 2502503 Category Nursing Job Family Case Manager Department Case Management Schedule Full-time Facility ... full-time RN Case Manager position available. The Registered Nurse Case Manager is responsible for...effectiveness through the integrating and functions of case management, utilization review and management and discharge planning.… more
- Beth Israel Lahey Health (Wakefield, MA)
- …care system considered in lieu of degree + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) ... in healthy behavior. Working with the healthcare team, the Care Manager, RN monitors appropriate utilization of healthcare resources, promotes quality and… more
- Banner Health (Greeley, CO)
- …the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in ... RN Case Manager, your work will be primarily remote with in clinic rounding every other month in...pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of… more
- Banner Health (Gilbert, AZ)
- …the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in ... be the opportunity you've been waiting for. As an RN Case Manager, you will contribute your expertise and...electronic surveillance partnership in caring for the patient, where remote nurses have the ability to interact with patients… more
- Sharecare (Pierre, SD)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- CVS Health (Atlanta, GA)
- …it all with heart, each and every day. **Position Summary** This Case Manager - Registered Nurse ( RN ) position is with Aetna's National Medical Excellence ... to apply, however, preference is for candidates in compact Registered Nurse ( RN ) states. This...is a blended role doing both Case Management and Utilization Management. The RN Case Manager is… more
- Bon Secours Mercy Health (Greenville, SC)
- …utilizing the nurse triage algorithms. Assists with the evaluation and review of all incoming ambulatory oncology referrals and may be asked to assist ... are recognized for clinical and operational excellence. **This position will work remote , following an initial on-site training period (approx. 90 days). The work… more
- CVS Health (Madison, WI)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... in a hospital setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- Summary The Referral Coordination Team (RCT) Registered Nurse ( RN ) is responsible for executing a streamlined approach to receiving, triaging, and directing ... intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Veterans Affairs, Veterans Health Administration (New Orleans, LA)
- Summary The Remote Patient Monitoring (RPM) Home Telehealth (HT) Registered Nurse ( RN ) Care Coordinator executes position responsibilities that ... equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion… more
- Veterans Affairs, Veterans Health Administration (Greenville, NC)
- …The Durham VA Healthcare System, Greenville is seeking (1) highly skilled/experienced Registered Nurse Educator to serve in Ambulatory Care. Demonstrates ... incumbent will be responsible for tracking the staff mandatory review requirements and partnering with management to achieve annual...services offered within that organization. The practice of the registered nurse in this position has a… more
- Veterans Affairs, Veterans Health Administration (Aurora, CO)
- Summary This is an OPEN-CONTINOUS ANNOUNCEMENT. The Outpatient Mental Health Registered Nurse is responsible and accountable for all elements of the nursing ... basis and will remain on file through 9-30-2025. Initial review will be conducted within two weeks from the...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Providence (Mission Hills, CA)
- **Description** RN - Utilization Review ...+ Associate's Degree in Nursing. + Upon hire: California Registered Nurse License + 2 years of ... Utilization Management, medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a diverse… more
- Insight Global (Philadelphia, PA)
- …Active RN License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review ) Strong computer skills Ability to ... looking for HEDIS RNs or LPNs for a partially remote contract position in PA and NJ. PARTIALLY ...Previous HEDIS review experience or experience with Utilization Review , Quality, Medical Record auditing Bachelors… more
- Help at Home (Cleveland, OH)
- …a clinically safe and fiscally responsible level of home care personnel utilization + Perform patient visits during peak periods or during staffing shortages ... assigned patient/client census for appropriateness and improved patient/client outcomes + Review patient medical records for Agency, accrediting body, local, state,… more
- US Tech Solutions (Columbia, SC)
- …+ Skill sets/qualities: Must have at least 2 years hospital experience, any other utilization review experience is great, different areas of work is always a ... queue they work the incoming cases out of. They review the requested procedure against the criteria we use...with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member… more
- Intermountain Health (Murray, UT)
- …verified. + Case management Certification. + Experience in Case management, Utilization review , and/or discharge planning. **Physical Requirements:** + Ongoing ... for evenings, nights and weekends This position is not remote , working in office is required. **Job Essentials** +...and other patient care teams. **Minimum Qualifications** + Current RN license for state in which the nurse… more