- Gentiva (Mooresville, NC)
- …a lasting difference in people's lives every day. **Overview** We're looking for a ** Utilization Manager ** to join our team. This position will directly report ... to the Director of Utilization Management and is responsible for planning, coordinating, implementing,...a Remote position with travel expectations. **About You** + Registered Nurse preferred + Bachelor's degree preferred… more
- CoreCivic (Brentwood, TN)
- …will pay $82,000 - $97,400 with a 10% bonus eligible._ **SUMMARY:** The Manager , Utilization Management/Case Management provides Utilization Review and Case ... a responsibility to better the public good. CoreCivic is currently seeking a ** Manager , Health Services Audits** located at our corporate office in Brentwood, TN.… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… more
- Trinity Health (Mason City, IA)
- …with documentation standards, policies, procedures and/or guidelines **Minimum Qualifications:** + Licensed registered nurse in the state of Iowa. + Bachelor's ... Full time **Shift:** Day Shift **Description:** **JOB SUMMARY:** The Utilization Review Case Manager responsibilities include case...of hire + Five years of experience as a registered nurse involving community contact, knowledge of… more
- LifePoint Health (Gallatin, TN)
- …or related healthcare field. **Job:** **Nursing* **Organization:** ** **Title:** * Utilization Mgmt Case Manager FT* **Location:** *Tennessee-Gallatin* ... Monitors adherence to the hospital's utilization review plan to ensure appropriate use of...- Case Management Minimum Education Associate's, Bachelor's degree or RN Diploma in Nursing - Required Required Skills Requires… more
- Beth Israel Lahey Health (Burlington, MA)
- …8:00am-4:30pm Weekend and holiday rotations required **Job Description:** The Inpatient Registered Nurse ( RN ) Case Manager for Hospital at Home Care ... a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse ...the needs of the department. **Minimum Qualifications:** Education: * Registered Nurse , Bachelors Degree or commensurate experience… 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 We ... Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance… more
- Humana (Frankfort, KY)
- …of experience working in Utilization Management processing clinical authorizations + Licensed Registered Nurse ( RN ) in the state of Kentucky (or compact ... part of our caring community and help us put health first** The Manager , Behavioral Health Utilization Management uses clinical knowledge, communication skills,… more
- UPMC (Hanover, PA)
- …required with 4-6 weeks of hire. UPMC approved Care Management certification preferred. + Registered Nurse ( RN ) + Act 34 *Current licensure either in ... **UPMC is hiring a part time Professional Care Manager for our Utilization Review department...preferred. **Licensure, Certifications, and Clearances:** Current licensure as a Registered Professional Nurse either in the state… more
- UCLA Health (Los Angeles, CA)
- …next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team ... a self-motivated, detail-oriented, service-driven leader with: + Current unrestricted RN licensure in CA required + Bachelors of Science,...(BSN) degree required + Five or more years of utilization management required + Four or more years of… more
- Ochsner Health (New Orleans, LA)
- …a difference at Ochsner Health and discover your future today!** This job is a registered Nurse with a diverse medical background, who is able to determine the ... Contents are subject to change at the company's discretion. **Education** Required - Registered Nurse Diploma or equivalent **Work Experience** Required - 1 year… more
- McLaren Health Care (Detroit, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay ... Functions and Responsibilities as Assigned:** 1. Collaborates with the UM RN to determine the appropriate hospital setting (inpatient vs. observation) based… more
- Ascension Health (Baltimore, MD)
- …job transfer date required. American Heart Association or American Red Cross accepted. + Registered Nurse obtained prior to hire date or job transfer date ... required. Education: + Required professional licensure/certification AND 3 years of experience and 1 year of cumulative leadership experience required. **Additional Preferences** \#ATP **Why Join Our Team** Ascension associates are key to our commitment of… more
- Centene Corporation (Olympia, WA)
- …+ Prior Authorization highly preferred + Medicaid experience highly preferred **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and facilitates… more
- Trinity Health (Lavonia, GA)
- **Employment Type:** Full time **Shift:** **Description:** The RN Case Manager ( RN CM), works in collaboration with a multidisciplinary team by identifying ... care throughout hospitalization in compliance with CMS and organizational utilization management requirements. RN CM helps to ensure medical necessity is met by… more
- Ochsner Health (Lafayette, LA)
- …medical management, or other related MCO departments/functions. **Certifications** Required - Current registered nurse ( RN ) license in state of practice. ... *MSW accepted in lieu of registered nurse ( RN ) licensure. Preferred - Certification in Case Management (CCM) or Certified Professional in Healthcare… more
- Ascension Health (Baltimore, MD)
- …situations, troubleshooting problems, and ensuring effective resolution to maintain smooth operations. ** Registered Nurse , Certified Case Manager (CCM, ACM, ... **Details** + **Department:** Utilization Management + **Schedule:** Hybrid work schedule available....of staff **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/204105/case- manager %2c- rn utilization ... an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute… more
- Alameda Health System (Oakland, CA)
- …or higher IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California Preferred Licenses/Certifications: ... System Utilization Management SUM Utilization Review RN + Oakland, CA...in orientation of fresh staff as requested by the Manager of Utilization Management. 17. Maintains knowledge… more
- Sutter Health (Modesto, CA)
- …patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely ... achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self -determination...an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of… more
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