- Ascension Health (Baltimore, MD)
- …problems, and ensuring effective resolution to maintain smooth operations. **Registered Nurse , Certified Case Manager (CCM, ACM, URAC) preferred or ... **Details** + **Department:** Utilization Management + **Schedule:** Hybrid work schedule available....staff **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date or job transfer… more
- Arnot Health (Elmira, NY)
- …areas suitable for nursing research. + Promotes research-based practice. Standard VIII. Resource Utilization The Nurse Manager evaluates and administers the ... DUTIES AND RESPONSIBILITIES: Standards of Care Standard I. Assessment The Nurse Manager develops, maintains, and evaluates patient/client and staff… more
- Arnot Health (Bath, NY)
- …areas suitable for nursing research. + Promotes research-based practice. Standard VIII. Resource Utilization The Nurse Manager evaluates and administers the ... Professional Performance Standard I. Quality of Care and Administrative Practice The Nurse Manager systematically evaluates the quality and effectiveness of… more
- UPMC (Hanover, PA)
- **UPMC is hiring a part time Professional Care Manager for our Utilization Review department in Hanover! This is a part time, day shift position with a rotating ... weekend and holiday schedule.** **Purpose:** The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization … more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical ... 8:00am-4:30pm Weekend and holiday rotations required **Job Description:** The Inpatient Registered Nurse (RN) Case Manager for Hospital at Home Care Transitions… more
- Lowe's (Charlotte, NC)
- …years of experience in a clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Experience in ... license in home State + CCM - Certified Case Manager + CRRN - Certified Rehabilitation Registered Nurse... Manager + CRRN - Certified Rehabilitation Registered Nurse + CDMS - Certified Disability Management Specialist +… more
- Trinity Health (Chelsea, MI)
- **Employment Type:** Part time **Shift:** Day Shift **Description:** **Registered Nurse Case Manager ** **Department:** Utilization Management **Location:** ... Chelsea, MI **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to support our vision...use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all members of… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Milford Regional Medical Center (Milford, MA)
- …to our community with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at ... Nursing required Masters in Healthcare preferred Certification/License: Massachusetts Registered Nurse licensure required Certified Case Manager , preferred… more
- Dignity Health (Gilbert, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use ... admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is...five (5) years of nursing experience + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or… 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
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical ... and verbal communication skills. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure Current RN license as… more
- Centene Corporation (Olympia, WA)
- …Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and facilitates ... operations within utilization management. + Manages prior authorization, concurrent review, and...Medicaid experience highly preferred **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The Manager , Behavioral Health Utilization Management uses clinical knowledge, communication skills, ... working in Utilization Management processing clinical authorizations + Licensed Registered Nurse (RN) in the state of Kentucky (or compact licensure) or Masters… more
- Houston Methodist (The Woodlands, TX)
- …Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient population on ... initiates discussion with attending physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from the physician… more
- 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 ... care for everyone, so we offer ongoing professional training, lower nurse -to-patient ratios, and comprehensive benefits for eligible employees. Here, you'll join… more
- Stanford Health Care (Palo Alto, CA)
- …- 08 Hour (United States of America) Department: Oth Ancillary Svcs - Utilization Mgmt Commitment: Full-time (1.0 FTE) 8-hr. Days Schedule: 8-hr, Day Shift Strongly ... years of experience as an RN - 3+ years of experience in case management/ utilization review Why work at Stanford Medicine | Stanford Health Care (SHC)? - Recognized… more
- BJC HealthCare (St. Louis, MO)
- …and risk of mortality utilizing strong communication skills with providers, case manager , utilization reviewer, nurse or other healthcare professionals, ... the Role** Join the BJC Health in a system wide Clinical Documentation Improvement Manager role. This role directly affects the financial impact of the system by… more
- Trinity Health (Mason City, IA)
- …Type:** Full time **Shift:** Day Shift **Description:** **JOB SUMMARY:** The Utilization Review Case Manager responsibilities include case screening, insurance ... Works directly with members of care team to effectively ensure appropriate acute utilization management + Interacts with outside review agencies and payors to inform… more
- Ochsner Health (New Orleans, LA)
- …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 psychosocial, ... are subject to change at the company's discretion. **Education** Required - Registered Nurse Diploma or equivalent **Work Experience** Required - 1 year of Hospital… more
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