- Alameda Health System (Oakland, CA)
- …plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic ... hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care....Required Licenses/Certifications : Valid license to practice as a Registered Nurse in the State of California.… more
- University Health (San Antonio, TX)
- …Three years recent, full time hospital experience preferred. Work experience in case management , utilization review , or hospital quality assurance experience ... clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF...of the State of Texas to practice as a registered nurse is required. National certification in… more
- Yale New Haven Health (New Haven, CT)
- …Works Under The Supervision Of The Nurse Manager/Clinical Coordinator. The Registered Nurse ( Rn ) Assesses, Plans, Implements, Evaluates And Supervises ... N/A LICENSURE Valid State Of Connecticut Registered Nurse License SPECIAL SKILLS BLS Required Additional Information Med/Surg RN experience required. more
- Yale New Haven Health (Bridgeport, CT)
- …Works Under The Supervision Of The Nurse Manager/Clinical Coordinator. The Registered Nurse ( Rn ) Assesses, Plans, Implements, Evaluates And Supervises ... Regarding Care For Patients. EXPERIENCE N/A LICENSURE Valid State Of Connecticut Registered Nurse License SPECIAL SKILLS BLS Required Additional Information… more
- Yale New Haven Health (Shelton, CT)
- …Works Under The Supervision Of The Nurse Manager/Clinical Coordinator. The Registered Nurse ( Rn ) Assesses, Plans, Implements, Evaluates And Supervises ... According To Unit Policies And Procedures. Provides Supervision Of Non- Rn Personnel On The Assigned Unit. When Assuming The...Care For Patients. EXPERIENCE N/A LICENSURE Valid State Of Connecticut Registered Nurse License SPECIAL SKILLS BLS… more
- University Health (San Antonio, TX)
- …Three years recent, full-time hospital experience preferred. Work experience in case management , utilization review or hospital quality assurance experience ... Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred....of the State of Texas to practice as a registered nurse is required. National certification in… more
- Baptist Memorial Health (Southaven, MS)
- …BMH - Desoto Hospital Department: DC Case Management Admin BMH Desoto Category: Nurse RN Type: Clinical Work Type: Full Time Work Schedule: Days Location: ... and/or life situation. Performs other duties as assigned. Responsibilities Utilization Review Discharge planning Readmission Reduction Participation Payer… more
- Harbor Health Services, Inc. (Mattapan, MA)
- …for more than 580 participants. We are currently seeking a Director of Utilization Management & Quality Programs. Harbor Health offers an excellent, ... Reporting to the Senior Director of Health Plan Operations, the Director of Utilization Management and Quality Programs is responsible for the day-to-day… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management - 2506004107 Description : Join our dedicated healthcare team where compassion meets innovation! As a ... Registered Nurse with us, you'll have the...for case management scope of services including: Utilization Management services supporting medical necessity and… 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 Barnstable counties. Our Nutrition Services Team consists of registered and licensed dietitians who provide expert nutritional interventions...and Serve Your Community!** **In your role as a Utilization Review & Denials Management … more
- Katmai (Fort Carson, CO)
- …Red Cross. + Three (3) years within the last four (4) years as a registered nurse in utilization management . + One (1) year of experience in UR/UM and ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management...full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate… more
- AmeriHealth Caritas (LA)
- **Role Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical ... to 2 weekends per year **Education & Experience** + Registered Nurse candidates: Associate Degree in Nursing...and American Society of Addiction Medicine (ASAM) criterion + Utilization management experience within a managed care… more
- US Tech Solutions (Chicago, IL)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in...+ Do you have experience with Utilization Review ? + Do you have an Active Registered… more
- US Tech Solutions (May, OK)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... . 1+ years of inpatient hospital experience . Registered Nurse in state of residence ....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST HAVE… more
- Providence (Polson, MT)
- …upon hire: Montana Registered Nurse License + 1 year experience in care management or utilization review in any setting or + Upon hire successful ... **Description** **Care Manager RN - Utilization Review ...working between 8am-6:30pm Sat/Sun & 8-12pm (Mondays)** The Inpatient Registered Nurse ( RN ) Care Manager… more
- Humana (Jackson, MS)
- **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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- CaroMont Health (Gastonia, NC)
- …license to practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management , Quality and/or Case Management ... to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments,… more
- Highmark Health (Harrisburg, PA)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... + Experience in UM/CM/QA/Managed Care + Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review experience **LICENSES AND… more
- Saint Francis Health System (OK)
- …in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the details ... Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 2...nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale… more
- Alameda Health System (San Leandro, CA)
- Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management + San Leandro, CA + John George Psychiatric Hospital + JGP Care Coordination + ... EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review ,...Department). Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State ofCalifornia.\ Pay… more
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