- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- Summary The Utilization Management (UM) Registered Nurse (RN) is responsible for UM reviews for patients who receive hospital care. Responsibilities An ... UM Registered Nurse is responsible for UM reviews...accreditation standards, and performance measures. Uses emergency and bed management software and utilization data to manage… more
- Humana (Louisville, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the state of… more
- McLaren Health Care (Indianapolis, IN)
- 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 subsidiary of ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- Aspen Medical (Aurora, CO)
- JOB AD: Registered Nurse - Utilization Management Introduction : Aspen Medical has an exciting opportunity for Registered Nurses to partner with us in ... Management through the American Nurses Credentialing Center or Utilization Management Accreditation through National Committee for...full, active, and unrestricted license to practice as a Registered Nurse as required in the TO… more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- Summary The Utilization Management (UM) Consultant is a registered professional nurse , qualified by education and experience to work directly with ... services, administrative officers, Emergency Department (ED) staff, and Bed Management . The nurse is responsible for applying...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. The Clinical Care Reviewer - Utilization Management will also be counted upon...required; Bachelor's Degree in Nursing (BSN) preferred. + A Registered Nurse (RN) license in the District… more
- Ellis Medicine (Schenectady, NY)
- Basic Function: The Utilization Management Registered Nurse (UM RN) supports daily coordination of care across healthcare continuum with the healthcare ... preoperative, concurrent and retrospective reviews in accordance with the utilization management program. The UM RN ensures...care related field required. Current registration as a Licensed Registered Professional Nurse in New York State.… more
- AdventHealth (Orlando, FL)
- …a holistic environment. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... and valid license to practice in Florida as a Registered Nurse (ADN or BSN) required. +...care clinical nursing experience required. + Minimum two years Utilization Management experience, or equivalent professional experience.… more
- Actalent (Des Moines, IA)
- Utilization Management Nurse - Job...utilization management unit. Essential Skills + Registered Nurse (RN) or Licensed Practical ... providers to resolve conflicts and explore alternative treatment settings. + Process utilization management requests using clinical knowledge and expertise. +… more
- HCA Healthcare (Nashville, TN)
- …3 years of relevant case management / utilization review experience preferred + Registered Nurse - Currently licensed as a registered professional ... you want to join an organization that invests in you as a Utilization Review Services Registered Nurse ? At Parallon, you come first. HCA Healthcare has… more
- McLaren Health Care (Pontiac, MI)
- …12. Performs other duties as assigned. #LI-KH1 _Required_ + State licensure as a Registered Nurse (RN) + Bachelor's degree in nursing from accredited educational ... requirements _Preferred:_ + Bachelor's degree in nursing + Experience in utilization management /case management /clinical documentation, critical care, or… more
- CVS Health (Springfield, IL)
- …administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of residence. + 3+ years of Nursing ... experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical experience. + Knowledge of… more
- HCA Healthcare (Nashville, TN)
- …1-4 years of relevant case management / utilization review experience preferred + Registered Nurse - Currently licensed as a registered professional ... **Description** **Introduction** Do you have the career opportunities as a(an) Utilization Review Services RN you want with your current employer? We have an… more
- Centene Corporation (Jefferson City, MO)
- …degree and 4+ years of related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse ... to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence… more
- Ochsner Health (New Orleans, LA)
- …develop and implement discharge plans based on patient's individualized needs. Registered Nurse (RN) Case Manager - Case Management OMC Jefferson Highway PRN ... experience in discharge planning, case management or utilization review. **Certifications** Required - Current registered ...or utilization review. **Certifications** Required - Current registered nurse license in state of practice.… more
- LifePoint Health (Louisburg, NC)
- …select a valid job field* **Organization:** **Maria Parham Franklin* **Title:** * Registered Nurse Utilization Review Coordinator* **Location:** ... Registered Nurse (RN) Utilization ... Registered Nurse (RN) Utilization Review Job Type:...days for patients. - Maintaining communication with the Case Management Department to facilitate timely discharge planning.. Reports to:… more
- Ascension Health (Manhattan, KS)
- **Details** + **Department:** Utilization Management + **Schedule:** FT Days; Monday - Friday 7:30am 4pm + **Hospital:** Ascension Via Christi + **Location:** ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** Part-time. Monday-Friday, 8:00AM-4:30PM. + **Facility:** St. Agnes Hospital + **Location:** ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- Prime Healthcare (Weslaco, TX)
- …InterQual Criteria preferred. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/210205/ registered - nurse -case-manager utilization - management ... Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to the… more
- The County of Los Angeles (Los Angeles, CA)
- …ambulation may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN that has Case Management experience whose primary charge ... OPTION II: Two (2) years of experience as a registered nurse , of which one year must...County of Los Angeles, a Utilization Review Nurse is an RN that has Case Management… more