- Alameda Health System (Oakland, CA)
- …of California. Preferred Licenses/Certifications : UM / CM certifications Highland General Hospital SYS Utilization Management Full Time Day Nursing FTE: 1 ... Overview: Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing... Nursing Preferred Education : Master's degree in Nursing Required Experience : Three years of utilization… 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 + ... Bachelor's degree in Nursing preferred. Minimum Experience: Previous Behavioral Health Utilization Management or Care Management experience in inpatient… more
- Katmai (Fort Carson, CO)
- …American 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 ... Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE...provisions within the catchment areas that affect the financial utilization of the Government by using professional nursing… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …an experienced **MD** to join our team as an **Assistant Medical Director ( Utilization Management - Oncology)** . The AMD will leverage their specialization ... addition, they will support clinical programs (disease and case management ), as well as the review and adoption of...additional clinical history in each case. + Consult with nursing and other clinical staff to assess and explore… more
- ERP International (Luke AFB, AZ)
- …algorithms, CM software, and databases for community resources. - Integrate CM and utilization management (UM) and integrating nursing case management ... **Overview** ERP International is seeking a full time **Registered Nurse - Case Management ** in support of...clinical nursing practice and education relevant to nursing and case management . - Participates in… more
- Luke Staffing (Yigo, GU)
- …of clinical nursing experience is required. One year of previous experience in Utilization Management is required. Full time employment in a nursing ... requirements of this position, it must be directly related to referral/ utilization management . + **Licensure:** Current, full, active, and unrestricted… more
- University of New Mexico - Hospitals (Albuquerque, NM)
- …not limited to experience, education, and other business and organizational considerations. Department: Utilization Management - UH Have you got what it takes to ... patient outcomes are achieved within established time frames and with efficient utilization of resources. Conduct initial and ongoing assessments, initiate disease … more
- Katmai (Fort Carson, CO)
- …analyze, update and record data. + Facilitate the development and integration of utilization management (UM) review policies and procedures into operations. + ... case manager as needed to provide direction in care management . + Plan and prioritize utilization review...**MINIMUM QUALIFICATIONS** + Graduation from a State Board of Nursing approved LPN/LVN training program or completion of equivalent… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …appropriate procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines. + Support medical policy ... and diagnosis codes for company medical policies and UM ( Utilization Management ) guidelines that reflect medical necessity, experimental/investigational… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- … nursing experience with advanced level pediatric clinical experience and utilization management and/or discharge planning experience. Thorough knowledge of ... **It's Work That Matters.** **Overview** **Purpose Statement/Position Summary:** The Nurse Care Manager performs complex discharge planning for patients...managed care, utilization management , discharges planning, and continuous quality… more
- University of New Mexico - Hospitals (Albuquerque, NM)
- …limited to experience, education, and other business and organizational considerations. Department: Utilization Management - UH Read on to fully understand what ... appropriate patients within designated specialty area requiring patient case management interventions by utilizing established procedures including census review,… more
- University of New Mexico - Hospitals (Rio Rancho, NM)
- …promote and facilitate communication, problem solving, decision-making, crisis intervention, resource utilization , and conflict management * PATIENT SAFETY - ... experience, education, and other business and organizational considerations. Department: Nursing Services Administration - SRMC All potential applicants are… more
- Christus Health (San Antonio, TX)
- …Medicare GMLOS by managing per Milliman/Interqual Care Guidelines. Resource/ Utilization Management /appropriateness: Assess assigned patient population for ... This position provides expertise and leadership to insure effective resource management for patient care delivery (Conditions of Participation COP 482.30). Case… more
- Katmai (Fort Carson, CO)
- …and providers, network/outside providers and ancillary healthcare workers. + Apply principles of utilization review (UR) and utilization management (UM) in ... beneficiaries. Ensure patient flow is optimized by assisting patients (CMHS Referral Management Team including the Central Referral Center- CRC and MTF Referral … more
- ERP International (Hurlburt Field, FL)
- …algorithms, CM software, and databases for community resources. - Integrate CM and utilization management (UM) and integrating nursing case management ... **Overview** ERP International is seeking a full time **Registered Nurse (RN) Case Manager** in support of the 1st...(CMP) and ensure that the CMP meets established case management (CM) standards of care. - Provide nursing… more
- ERP International (Twentynine Palms, CA)
- …algorithms, CM software, and databases for community resources. - Integrate CM and utilization management (UM) and integrating nursing case management ... **Overview** ERP International is seeking **Registered Nurse (RN) Case Managers** for full-time positions in...(CMP) and ensure that the CMP meets established case management (CM) standards of care. - Provide nursing… more
- UnitedHealthcare (New Orleans, LA)
- …or experience as a telephonic Case Manager Medical-Surgical/ICU/ED experience Case Manager/ Utilization Management experience Demonstrated ability to keep all ... the member's medical, behavioral, and socioeconomic needs to promote appropriate utilization of services. We're connecting care to create a seamless health… more
- ERP International (Tinker AFB, OK)
- …algorithms, CM software, and databases for community resources. - Integrate CM and utilization management (UM) and integrating nursing case management ... (CMP) and ensure that the CMP meets established case management (CM) standards of care. - Provide nursing...no limitations, stipulations or pending adverse actions) to practice nursing as a registered nurse in any… more
- University Health (Pleasanton, TX)
- …years of clinical nursing experience is required. Data entry, referral management , utilization management experience is required. Case Management ... outcomes, compliance, and decrease complications. EDUCATION/EXPERIENCE Graduation from an accredited school of nursing , RN or LVN is required. A minimum three… more
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