- CoxHealth (Branson, MO)
- …and utilization of Aseptic Technique. Licensure/Certification/Registration: ▪ Required:Missouri State Registered Nurse AND Certified as a Registered ... and utilization of Aseptic Technique. ◦ Licensure/Certification/Registration ▪ Required:Missouri State Registered Nurse AND Certified as a Registered … more
- Ventura County (Ventura, CA)
- Per Diem Registered Nurse II/III - Utilization Management ... II + Six (6) months of experience in Utilization Management Per Diem RN III ... VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply Per Diem Registered Nurse II/III - Utilization Management VCMC… more
- Tufts Medicine (Burlington, MA)
- …to the utilization of resources, coordination of care across the continuum and utilization review and management . The position develops and leads the ... in Nursing (BSN). 2.Massachusetts RN Licensure. 3. Current certification in case/ utilization management (ACM, CCM, CMAC) 4. Seven (7) years of UM/Case… more
- Centene Corporation (Columbus, OH)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks...position open to candidates nationwide.** **Candidates must have a Registered Nurse ( RN ) license for… more
- Centene Corporation (Phoenix, AZ)
- … utilization management . + Oversees the behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines + Reviews ... Tucson offices.** **Position Purpose:** Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care...+ Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse -… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse ( RN )** for a full-time position supporting the 2d Medical ... in Utilization Management is required. Full time employment as a registered nurse within the last 36 months is mandatory. Six years of clinical… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- Crouse Hospital (Syracuse, NY)
- …and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse ( RN ) to track and manage data ... 8:00am-4:30pm, requires 6 weekends a year. Utilization Management Registered Nurse ( RN...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… more
- State of Indiana (Indianapolis, IN)
- …The role of Utilization Management Manager oversees the integration of utilization review , clinically appropriate care and risk management for the ... Utilization Management Manager Date Posted: Sep...and clinical criteria evaluations.They will possess a current unrestricted RN license from the State of Indiana; a minimum… more
- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- McLaren Health Care (Flint, MI)
- We are looking for a Utilization Management RN , to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- Wellpath (Fort Lauderdale, FL)
- …for training, education, and point of care support. **How you make a difference** The Utilization Management Registered Nurse works under the guidance of ... accordance with applicable state and local laws. Quick Apply (https://careers-wellpath.icims.com/jobs/181904/ utilization - management - registered - nurse -%28rn%29/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336175207) **Need help… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- AdventHealth (Daytona Beach, FL)
- …**The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse ( RN ) is to use clinical expertise by analyzing patient ... including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable...of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,… more
- Humana (Augusta, ME)
- …areas. **Use your skills to make an impact** **Required Qualifications** + An active, unrestricted Registered Nurse ( RN ) license in the state of Michigan. + ... Previous experience in utilization management and/or utilization review . + Minimum of two (2) years of proven experience in management or leadership… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members who may ... use of the member's benefit to provide the best quality care. The TeamThe Clinical Utilization Reviewer is part of a highly dedicated and motivated team of… more
- Actalent (Santa Barbara, CA)
- Remote Utilization Management RN Leading...and helpful team + Fully remote!! REQUIREMENTS: + California Registered Nurse ( RN ) and/or ... working as soon as possible! Description: + REMOTE + RN with experience in providing Case Management ...alpha resource center, parents helping parents, etc. knowledge of Utilization Management process/ turnaround times. + Familiar… more
- CareFirst (Baltimore, MD)
- …+ Proficient in Microsoft Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\ RN - Registered Nurse - State Licensure and/or ... week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages… more
- Molina Healthcare (GA)
- …experience. * At least 1 year of health care management /leadership experience. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), Licensed ... or more of the following activities: care review , care management , utilization management (prior authorizations, inpatient/outpatient medical necessity,… more
