- Aequor (New York, NY)
- …services to employees within regulated scope of practice and disability case management . Experience/Education: MS/NP in nursing degree and current NP license ... nursing professional Minimum experience of 1-3 years in case management , utilization review and/or quality assurance Experience in episodic care,… more
- CHRISTUS Health (San Antonio, 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
- CHRISTUS Health (San Antonio, TX)
- … practice and operations for assigned areas; 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
- The University of Vermont Health Network (Elizabethtown, NY)
- …employee health documents and reports. The manager is a registered professional nurse manager who is responsible for conducting inpatient Care Management ... nursing field. BSN preferred.* Must be a Registered Nurse (RN), licensed in good standing in NYS. Must...regulations, clinical practice guidelines, and quality issues related to utilization management with application for appeals and… more
- CHRISTUS Health (Alamogordo, NM)
- …screening, monitoring, and reporting individual cases and/or trends to the infection control nurse . Performs utilization management functions as required by ... of discharge plans. Makes self available as resource to nursing staff. Provides learning experiences to strengthen and expand...payer source. Complies with the Utilization Management Plan. Requirements Education Required: Associate… more
- Humana (Columbus, OH)
- …help us put health first** Humana Healthy Horizons in Virginia is seeking a Manager , Utilization Management (Behavioral Health) who will utilize their ... communication of behavioral health services and/or benefit administration determinations. The Manager , Utilization Management (Behavioral Health) applies a… more
- UCLA Health (Los Angeles, CA)
- …the 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 ... RN licensure in CA required + Bachelors of Science, Nursing (BSN) degree required + Five or more years...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- Elevance Health (Washington, DC)
- …degrees of medical complexity and acuity. Participates in case and/or utilization management execution/decision making for managed member populations. Primary ... state or federal requirements that may apply is required. + Masters in related Health/ Nursing field preferred. + Certified Case Manager Certification preferred. more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Manager Utilization Management Nursing utilizes clinical nursing skills to ... documentation and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …performance/quality improvement activities that lead to optimal patient outcomes. A Case Manager differs from other roles in professional nursing /health care ... nature, level and purpose of the job. Case Managers are licensed nursing professionals responsible for coordinating continuum of care and discharge planning… more
- Universal Health Services (Dearborn, MI)
- Responsibilities Utilization Management Case Manager Beaumont Behavioral Health (a UHS Facility) A growing 144-bed behavioral health facility - Beaumont ... more information, please visit our website: https://beaumontbh.com/ PositionSummary The Utilization Management Case Manager is...in social work, counseling or a Michigan licensed Registered Nurse is required. + Full licensure in the State… more
- Trinity Health (Fresno, CA)
- …Review of Acute Care seeking your next adventure?** **Duration:** 13-week Assignment The Interim Utilization Management , RN Manager is responsible for ... healing mission of Saint Agnes Medical Center. The RN Manager of Utilization Management will...and hospital staff **Requirements** + State of California Registered Nurse (RN) License. + Current American Heart Association (AHA)… more
- UNC Health Care (Chapel Hill, NC)
- …communities we serve. RN Utilization Manager position specifically for a Utilization Manager /Clinical Appeals Nurse . This person is based at the ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to… more
- Highmark Health (Pittsburgh, PA)
- …years with utilization review/ management + 1 year as a supervisor or manager of Utilization /Case Management with a Managed Care Organization + 1 year ... customers of Helion's technology platform(s). **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved… more
- Mountains Community Hospital (Lake Arrowhead, CA)
- Full Time - Exempt position SUMMARY The Case Manager is responsible for utilization management and case management of patient admissions at MCH by ... knowledge of state and federal regulations. EDUCATION/EXPERIENCE Current California Registered Nurse License Five years nursing experience required CERTIFICATES,… more
- AmeriHealth Caritas (Newark, DE)
- ** Utilization Management Plan Oversight Manager , Registered Nurse (must reside in DE)** Location: Newark, DE Primary Job Function: Medical Management ... UM DE, and serves as SME for clinical components DE Medicaid Utilization Management Program. Works in close collaboration with all departments to achieve… more
- Sharp HealthCare (San Diego, CA)
- …System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center ... American Case Management Association (ACMA); California Registered Nurse (RN) - CA Board of Registered Nursing...Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager… more
- Dignity Health (Rancho Cordova, CA)
- …home.** **Position Summary:** Under the guidance and supervision of the department Manager /Director, the Supervisor of Utilization Management is responsible ... Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management... skills. - Graduate of an accredited school of nursing . - Clear and current CA Registered Nurse… more
- Ellis Medicine (Schenectady, NY)
- …is to work with the Social Worker, Nurse Case Manager , or Utilization Management Nurse to facilitate patient discharge plans, support coordination of ... beneficiaries per CMS Conditions of Participation at the direction of the Case Manager . + Utilization Management Activities: + Collaborates with Case… more
- LA Care Health Plan (Los Angeles, CA)
- …Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range ... the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and… more
