- UPMC (Hanover, PA)
- **UPMC is hiring a part time Professional Care Manager for our Utilization Review department in Hanover! This is a part time, day shift position with a rotating ... weekend and holiday schedule.** **Purpose:** The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization … more
- Lowe's (Charlotte, NC)
- …years of experience in a clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Experience in ... license in home State + CCM - Certified Case Manager + CRRN - Certified Rehabilitation Registered Nurse...or local law._ _Qualified applicants with arrest or conviction records will be considered for Employment_ _in accordance with_… 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 Type: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Dignity Health (Gilbert, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical ... performance improvement of the UR KPI's. Ensures proper and accurate medical record documentation. **Essential Functions** + Reviews new admissions using 3rd party… more
- Centene Corporation (Olympia, WA)
- …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 review, and...Medicaid experience highly preferred **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Houston Methodist (The Woodlands, TX)
- …Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient population on ... initiates discussion with attending physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from the physician… more
- Stanford Health Care (Palo Alto, CA)
- …- 08 Hour (United States of America) Department: Oth Ancillary Svcs - Utilization Mgmt Commitment: Full-time (1.0 FTE) 8-hr. Days Schedule: 8-hr, Day Shift Strongly ... years of experience as an RN - 3+ years of experience in case management/ utilization review Why work at Stanford Medicine | Stanford Health Care (SHC)? - Recognized… more
- Ochsner Health (New Orleans, LA)
- …heal, lead, educate,** **and innovate. We believe** **that every award earned, every record broken and every patient helped is because of the dedicated employees who ... discover your future today!** This job is a registered Nurse with a diverse medical background, who is able...high pressure situations. Preferred- Experience in Case Management or Utilization Review Business and Financial Knowledge as well as… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/204105/case- manager %2c-rn utilization ... perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.… more
- Alameda Health System (Oakland, CA)
- …requirements. 16. Participate in orientation of fresh staff as requested by the Manager of Utilization Management. 17. Maintains knowledge of current trends and ... System Utilization Management SUM Utilization Review RN...system. 9. Conduct concurrent and admission reviews of patient records to assess medical necessity and adherence to evidence-based… more
- Baptist Memorial (Meridian, MS)
- …Job Description Title: RN Utilization Review Weekender Job Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and ... appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works with providers, insurance companies and… more
- Cleveland Clinic (Cleveland, OH)
- …of the most respected healthcare organizations in the world. As a Utilization Management Specialist, you will perform UM activities, such as admission, concurrent, ... who excels in this role will: + Recommend resource utilization . + Prioritizes and organizes work to meet changing...results effectively. + Use independent clinical judgment in reviewing records to determine status of patients stay, if proper… more
- Ochsner Health (Lafayette, LA)
- …heal, lead, educate,** **and innovate. We believe** **that every award earned, every record broken and every patient helped is because of the dedicated employees who ... or other related MCO departments/functions. **Certifications** Required - Current registered nurse (RN) license in state of practice. *MSW accepted in lieu… more
- The Arora Group (Bethesda, MD)
- Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse (RN) Case Manager to work the Directorate of Healthcare Operations (DHO) ... with decision-making and process improvement. + Report to the Nurse Manager , and take direction from the...(RN-NCM) + National Academy of Certified Care Managers: Care Manager Certified (CMC) + Experience: + Referral Management/ Utilization… more
- Elevance Health (Ashburn, VA)
- ** Utilization Management Representative II** **Location:** Within 50 miles of a Pulse Point location in Virginia or North Carolina. **Hours:** Monday - Friday, from ... 9:30 am - 6:00 pm EST. The ** Utilization Management Representative II** is responsible for managing incoming...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Elevance Health (Rocky Hill, CT)
- ** Utilization Management Representative I** **Location:** Within 50 miles of Wallingford or Rocky Hill, Connecticut **Hours:** Monday - Friday, from 8:30 am - 5:00 ... pm EST. The ** Utilization Management Representative I** is responsible for coordinating cases...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- Elevance Health (Columbus, GA)
- ** Utilization Management Representative II** **Location :** Seeking candidates that reside within 50 miles of the **Atlanta, GA** or **Columbus, GA** PulsePoint ... days per week will be during these hours.** The ** Utilization Management Representative II** is responsible for managing incoming...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Elevance Health (Houston, TX)
- ** Utilization Management Representative II** **Location:** Within 50 miles of a Pulse Point location. **Hours:** Monday - Friday, 11:30 am - 8:00 pm EST The ** ... Utilization Management Representative II** is responsible for managing incoming...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Elevance Health (Topeka, KS)
- ** Utilization Management Representative I** **Location:** Within 50 miles of a Pulse Point in Nevada, Kansas, or Texas **Hours:** Monday - Friday, an 8-hour shift ... hours of 7 am and 6 pm PST. The ** Utilization Management Representative I** is responsible for coordinating cases...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
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