- CHRISTUS Health (Balcones Heights, TX)
- …and operations for assigned areas; at CHRISTUS St. Patrick Hospital. The nurse manager affects departmental outcomes through interpretation, implementation, and ... excellence in patient care, patient experience and patient outcomes. Effectively manages utilization of staff and material resources so that the most therapeutically… more
- Appcast (Randallstown, MD)
- …schools. This requirement will be lifted for LBH candidates employed as a Utilization Review Nurse , Clinical Care Coordinator, Patient Care Integrator or RN ... Inpatient Care Manager Sign On Bonus Potential: 10,000 Randallstown, MD...strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimize denials of payment… more
- Daiichi Sankyo, Inc. (Chesapeake, VA)
- …meet targeted customer needs.Monitor, collect, and communicate to the Director, Clinical Nurse Manager on customer insights regarding their need for information ... nurses working under the general direction of the Regional Director of Clinical Nurse Managers. The OCE is responsible for educating HCPs/clinics with infusion and… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring… more
- University Medicine (Providence, RI)
- …home members to assist the patient to the right level of care and decrease unnecessary utilization . The nurse case manager is an active participant in the ... SUMMARY: Reporting to the Manager of Case Management, the nurse ...from high-risk case management (eg rising risk, frequent ED utilization ). The NCM helps Brown Medicine achieve the triple… more
- AdventHealth (Mansfield, TX)
- …care and services of selected patient populations across the continuum of illness. The Nurse Manager promotes effective utilization of health care resources, ... all ages, and a growing business community. **The role you'll contribute:** The Nurse Manager is a specialized health care professional who adheres to the goals,… 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
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests for ... use of services. Under the general supervision of the Director and/or Manager /Supervisor of Medical Management, and in collaboration with the interdisciplinary team,… more
- University of Utah Health (Salt Lake City, UT)
- …advancement, and overall patient outcomes. **Responsibilities** + Applies approved utilization criteria to monitor appropriateness of admissions with associated ... or third-party payer. + Alerts and discusses with physician/provider and case manager /discharge planner when patient no longer meets medical necessity criteria for… more
- Monroe County, NY (Rochester, NY)
- …The employee reports directly to, and works under the general supervision of a Nurse Manager , or other higher-level staff member. General supervision may be ... Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse (RN) - … more
- Dayton Children's Hospital (Dayton, OH)
- …Utilization Review TeamSchedule:Full timeHours:40Job Details:Under the supervision of the Manager of Utilization Management, the Utilization Review ... information to payers in accordance with contractual obligations. The Utilization Review RN serves as a resource to the...a resource to the physicians, collaborates with the Care Manager in the development and implementation of the plan… more
- Molina Healthcare (Los Angeles, CA)
- …in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), ... Job Duties** * Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with… more
- Beth Israel Lahey Health (Plymouth, MA)
- …the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Beth Israel Lahey Health (Plymouth, MA)
- …the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to work ... ) required or completed within three years of hire **Title:** * Utilization Review Manager * **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:**… more
- Ascension Health (Baltimore, MD)
- …for post-discharge care. **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date or job transfer date required. + ... Heart Association or American Red Cross accepted. + Case Manager credentialed from the Commission for Case Manager... Manager credentialed from the Commission for Case Manager Certification (CCMC) preferred. Education: + Diploma from an… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing the ... daily operation of the Utilization Management Review Nurse and Specialist staff...decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director… more
- Molina Healthcare (GA)
- …in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), ... more of the following activities: care review, care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition… more
- Centene Corporation (Phoenix, AZ)
- …and/or Tucson offices.** **Position Purpose:** Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care to members. Oversees and ... works with senior leadership on utilization management issues related to member care, provider interactions,...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Humana (Augusta, ME)
- …a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management Leader) utilizes ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific guidelines… more
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