- CoreCivic (Brentwood, TN)
- …position will pay $82,000 - $97,400 with a 10% bonus eligible._ **SUMMARY:** The Manager , Utilization Management /Case Management provides Utilization ... government laws and regulations. + Manages a team of utilization management nurses.Provides direction and supports staff...years of hospital, health care system, or health plan nursing experience is required. + Case Management … more
- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Manager , Behavioral Health Utilization Management uses clinical knowledge, communication ... overseeing staff + 2 + years of experience working in Utilization Management processing clinical authorizations + Licensed Registered Nurse (RN) in the state… 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 ... RN licensure in CA required + Bachelors of Science, Nursing (BSN) degree required + Five or more years...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager...+ Current MA RN Licensure required; Bachelor's degree in nursing , health care administration or related field preferred or… more
- Centene Corporation (Olympia, WA)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent...**Education/Experience:** + Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 5+ years of related… more
- Prime Healthcare (Anaheim, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/199249/case- manager utilization - management ... in a related field or at least one year experience in case management , discharge planning or nursing management ; + CCM or obtained within 6 months of hire.… more
- Alameda Health System (Oakland, CA)
- …Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:41907-31045 + FTE:1 + ... in orientation of fresh staff as requested by the Manager of Utilization Management . 17....QUALIFICATIONS:** Required Education: BSN from an accredited school of nursing Preferred Education: Master's degree in nursing … more
- Prime Healthcare (National City, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/205657/case- manager pvh- utilization - management ... degree in a related field. At least one year experience in case management , discharge planning or nursing management ; + CCM or obtained within 6 months of… more
- Stanford Health Care (Palo Alto, CA)
- …practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, ... an RN - 3+ years of experience in case management / utilization review Why work at Stanford Medicine...effective plan to address them. **Licenses and Certifications** + Nursing / RN - Registered Nurse -… more
- Trinity Health (Chelsea, MI)
- …Part time **Shift:** Day Shift **Description:** **Registered Nurse Case Manager ** **Department:** Utilization Management **Location:** Chelsea, MI ... **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to support our vision...use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all members of… more
- Penn Medicine (Philadelphia, PA)
- …their critical thinking skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, ... fearful you will miss patient contact? If so, our nurse case manager role at Penn Medicine...community resources, transportation, and quality data collection and risk management referral. + Responsibilities: Utilization management… more
- UPMC (Hanover, PA)
- …(CM) coordinates the clinical and financial plan for patients. Performs overall utilization management , resource management , discharge planning and ... **UPMC is hiring a part time Professional Care Manager for our Utilization Review department...required with 4-6 weeks of hire. UPMC approved Care Management certification preferred. + Registered Nurse (RN)… 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 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** Hybrid work schedule available. Monday-Friday, 8:00AM-4:30PM. + **Hospital:** Ascension St. ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
- Milford Regional Medical Center (Milford, MA)
- …with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR ... and appeal process under the guidance of the UR Manager . Qualifications: Education: Bachelor of Science in Nursing...experience Minimum of 1 year Nurse Case Management experience Minimum of 1 year Utilization … more
- The Arora Group (Bethesda, MD)
- …Managers: Care Manager Certified (CMC) + Experience: + Referral Management / Utilization Management (RM/UM) experience. + Clinical subspecialty experience ... Registered Nurse Case Manager Nurse ...a senior nursing leader and advances the nursing profession in case management . Introduces innovative… more
- Dignity Health (Gilbert, AZ)
- …**Responsibilities** Under the general direction of the Director of Care Management , performs criteria-based concurrent and retrospective utilization review to ... hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of...healthcare field + At least five (5) years of nursing experience + Certified Case Manager (CCM),… more
- Beth Israel Lahey Health (Burlington, MA)
- …years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ability ... a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse ...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and… more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding ... + Collaborates with the multidisciplinary team to assess and improve the denial management , documentation, and appeals process. + Collaborates with UR Manager … more
- Dartmouth Health (Lebanon, NH)
- …preferred, ie, Certified Professional in Healthcare Quality (CPHQ), Certified Case Manager (CCM), Certified Professional Utilization Management (CPUM), ... desired * Extensive knowledge of payer mechanisms and clinical utilization management is required. * Possesses working...Case Manager (CCM) OR Certified Accredited Case Manager (ACM) OR Case Management Administrator (CMA)… more
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