- Ventura County (Ventura, CA)
- …Registered Nurse III - Hospital Case Management / Utilization Review Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4396275) Apply ... Diem Registered Nurse III - Hospital Case Management / Utilization Review Salary $119,061.54 - $151,803.47 Annually...than 5:00 pm on Friday, May 3, 2024. To apply on-line, please refer to our web site at… more
- ERP International (Tinker AFB, OK)
- …and Tasks: Duties may include but are not limited to** : Provides Utilization Management activities and functions by using MTF-specific Quality Improvement ... **Overview** ERP International, LLC is seeking a **Registered Nurse - Utilization Managment** for a...and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case… more
- CVS Health (Harrisburg, PA)
- …Consultant role is 100% remote and the candidate can live in Pennsylvania. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... coordinate, document and communicate all aspects of the utilization /benefit management program. You would be responsible for ensuring the member is receiving the… more
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Title:** Nurse Senior_ Utilization Management Lead **Shift** : M-F 8hr days/Hybrid (2 ... days in Office) **Position Summary** : The Registered Professional Utilization Management Lead is responsible for upholding...of nursing. 2. Current registration as a Registered Professional Nurse in New York State. 3. Bachelor of Science… more
- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. ... Job Summary: Our Utilization Management Appeals Nurse -...your interest in Acentra Health and invite you to apply to future openings that may be of interest.… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- EM Key Solutions, Inc. (Eglin AFB, FL)
- …EM Key Solutions is seeking Registered Nurse (RN) for a full-time Utilization Review / Management position supporting the Medical Maintenance Team at Eglin ... Eglin AFB, FL, USA | Full Time Registered Nurse - Utilization Manager Onsite Position...to the following: + Develops and implements a comprehensive Utilization Management plan/program in accordance with the… more
- EM Key Solutions, Inc. (Eglin AFB, FL)
- …EM Key Solutions is seeking a Registered Nurse (RN) for a full-time Utilization Review / Management position supporting the Medical Maintenance Team at Eglin ... AFB, FL, USA | Hourly | Full Time Registered Nurse - Utilization Manager Location: Eglin Hospital...to, the following: + Develops and implements a comprehensive Utilization Management plan/program in accordance with the… more
- Beth Israel Lahey Health (Burlington, MA)
- …Functions and Responsibilities:** Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that ... payer certification, and denied cases. Monitors effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics,… more
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- CVS Health (Harrisburg, PA)
- …and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with ... to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal...Qualifications - 3+ years of experience as a Registered Nurse - Must have active current and unrestricted RN… more
- Trinity Health (Fresno, CA)
- …of Acute Care seeking your next adventure?** **Duration:** 13-week Assignment The Interim Utilization Management , RN Manager is responsible for management , ... leadership, and coordination of the Utilization Management Team to ensure payor reimbursement for services rendered while supporting the healing mission of Saint… more
- Ascension Health (Pensacola, FL)
- …and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification ... specifics._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review. + Review… more
- Ascension Health (Wichita, KS)
- …and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification ... specifics._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review. + Review… more
- CVS Health (Columbus, OH)
- …in New Albany OH, Chandler AZ or High Point NC Precertification Nurse Case Manager is responsible for telephonically assessing, planning, implementing and ... coordinating all case management activities with members to evaluate the medical needs...and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10… more
- Actalent (Kansas City, MO)
- …+ MINIMUM 2 years clinical experience in a clinical setting + Experienced in Utilization Management and knowledge of URAC & NCQA standards + Broad knowledge ... Sunday to Thursday OR Tuesday to Saturday basis doing utilization review for PAC patients. This role is looking...Interviews are being set up quickly with equipment provided. Apply today if you are looking for a new… more
- Corewell Health (Southfield, MI)
- …everyone. Together, we are Corewell Health. Scope of work The Clinical Utilization Management (UM) Supervisor is responsible for monitoring, supervising, and ... performing daily Utilization Management functions, which includes but is...and complexity comparable to Corewell Health. Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required… more
- UNC Health Care (Raleigh, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... case management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization management… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness ... of services as well as appropriate utilization of services; and ensuring optimum use of resources,...delivery and quality of patient care. A hospital-based case management system has as its primary goal to ensure… more
- Humana (Columbus, OH)
- …and help us put health first** Full-Time Remote, Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral health ... and Utilization Management experience. The Utilization Management Behavioral Health Nurse ...decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited… more