- CHRISTUS Health (Arp, TX)
- DescriptionSummary: The Registered Nurse Patient Navigator Lead is a Registered Nurse or licensed Nurse Practitioner who provides health and wellness ... and other providers. Incumbent oversees integrated data warehouse including program utilization , disease management programs and contracted provider network… more
- CHRISTUS Health (San Antonio, TX)
- …for assigned areas; at CHRISTUS St. Patrick Hospital. The nurse manager affects departmental outcomes through interpretation, implementation, and evaluation ... excellence in patient care, patient experience and patient outcomes. Effectively manages utilization of staff and material resources so that the most therapeutically… more
- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication ... best and most appropriate treatment, care, or services for Enrollees. The Utilization Management Nurse Lead coordinates and communicates with Providers,… more
- The County of Los Angeles (Los Angeles, CA)
- …ambulation may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience whose primary charge ... so may result in an incomplete application and may lead to disqualification. We will send notifications to the...County of Los Angeles, a Utilization Review Nurse is an RN that has Case Management… more
- Houston Methodist (Houston, TX)
- …the leadership team for special project activities related but not limited to, throughput, utilization review and utilization management to align with the ... At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position...members. + Serves as the primary information resource for utilization management staff, payers, physicians, and other… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 250924-5613FP-001 Location East Hartford, CT Date Opened 9/30/2025 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=)… more
- Molina Healthcare (Los Angeles, CA)
- …care experience, and at least 2 years of managed care experienced utilization management . * Ability to manage conflict and lead through change. * Operational ... in some or all of the following functions: care management , utilization management , behavioral health,...in good standing. **Preferred Qualifications** * LVN (Licensed vocational nurse ) or RN (Registered Nurse ) . License… more
- CVS Health (OH)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position ... Summary** The Team Lead plays a key role in supporting the daily...in medical healthcare. + 3+ years Medical Review or Utilization Management experience. + 2+ years of… more
- Commonwealth Care Alliance (Boston, MA)
- …Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing...necessarily performed by each individual in the classification. + Lead and manage a team of utilization … more
- Molina Healthcare (GA)
- …of healthcare services professionals in some or all of the following functions: utilization management , care management , behavioral health and other ... of the following key health care services functions: care management , utilization management , care transitions,...and experience. * At least 3 years health care management /leadership required. * Registered Nurse (RN), Licensed… more
- Trinity Health (Albany, NY)
- …our world and that these differences often lead to innovative solutions. **Registered Nurse Professional Utilization Management Nurse - St. Peter's ... and shifts to accommodate all schedules **What you will do:** + Perform utilization management , both concurrent and retroactive for inpatient and outpatient… more
- CVS Health (UT)
- …+ 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals experience in Utilization ... Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible...ability to serve as a model change agent and lead change efforts + Create a positive work environment… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... financial, and utilization goals through effective management , communication, and...to 5) years of professional leadership experience (ie, charge nurse , team leader, preceptor, committee chair, etc.) * Five… more
- Prime Healthcare (Inglewood, CA)
- …Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients ... are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case ...and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and… more
- Elevance Health (Cerritos, CA)
- ** Utilization Management Representative II** **Location:** Virtual: This role enables associates to work virtually full-time in **CALIFORNIA** , with the ... shift between 8 am - 5 pm PST. The ** Utilization Management Representative II** is responsible for...providers. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Trinity Health (Maywood, IL)
- …in collaboration with attending physicians. + Actively participates in the Utilization Management committee. + Additional responsibilities as needed. **We ... Loyola campus. Position is hybrid, must reside in Illinois. The **Regional Utilization Review Documentation Specialist** nurse works with the multidisciplinary… more
- Elevance Health (Miami, FL)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- Elevance Health (Mason, OH)
- ** Utilization Management Representative II** **Schedule: Monday-Friday 8am-5pm Eastern Time** **Must be located in the state of Ohio** **Virtual** : This role ... given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +...eligibility information. + May act as liaison between Medical Management and internal departments. + Responds to telephone and… more
- AdventHealth (Tampa, FL)
- …in conducting performance appraisals for personnel on assigned shift. The Registered Nurse provides self-directed, effective nursing care to groups of patients and ... with customer service behaviors and reinforces hospital goals for service management . PEOPLE: * Adheres to organizational standards for dress and professional… more
