- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Compliance Utilization Management Nurse 2 reviews utilization ... a rotating schedule. (about 2 holidays per year) The Compliance Utilization Management Nurse...make an impact** **Required Qualifications** + Active unrestricted Licensed Registered Nurse , ( RN ), in your… more
- Beth Israel Lahey Health (Burlington, MA)
- …other related duties as required and directed. **Qualifications:** Required Licensure as a Registered Nurse ( RN ), Massachusetts Three years of recent ... high-level proficiency in navigating the Electronic Medical Record and applications related to utilization management . Compliance with the Code of Ethics and… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …mitigation strategies. Your Day to Day: + With minimal oversight, leads CMS utilization management related compliance activities including: + Identify and ... theory What You Bring: + Active and Unrestricted Massachusetts Registered Nurse license required + Bachelor's degree...+ 3-5 years' experience working with CMS Part C utilization management organization determination compliance … more
- LA Care Health Plan (Los Angeles, CA)
- …Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse ( RN ); current and unrestrited California License. ... Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The expected pay… more
- Centene Corporation (Austin, TX)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... (UM) to align to goals and objectives + Develops, implements, and maintains compliance with utilization management policies and procedures + Reviews … more
- Trinity Health (Hartford, CT)
- …**What you will do:** + Provide patient Centered Leadership while ensuring effective utilization management , compliance with Medicare requirements, and the ... Degree Preferred + **Licensure** : Current Licensure as a registered nurse ( RN ) in Connecticut...criteria, JCAHO and CMS requirements for discharge planning and utilization management **Position Highlights and Benefits** +… more
- Molina Healthcare (Bronx, NY)
- …and monitoring clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and ... on the severity of illness and the site of service. **We are seeking a Registered Nurse with previous UM and** **inpatient experience along with knowledge of the… more
- Trinity Health (Springfield, MA)
- …our Care Coordination Department. Provide patient-centered leadership while ensuring effective utilization management , compliance with Medicare requirements, ... - Master's Degree Preferred + Current Licensure as a registered nurse ( RN ) in Massachusetts...criteria, JCAHO and CMS requirements for discharge planning and utilization management **Position Highlights and Benefits**… more
- RWJBarnabas Health (Livingston, NJ)
- Case Manager Registered Nurse ( RN ), Case...setting + Minimum of one year experience in Case Management / Utilization Management or Home Care ... Barnabas Medical Ctr, 94 Old Short Hills Road, Livingston, NJ 07039 The Case Manager Registered Nurse develops safe discharge plans in order to reduce length of… more
- Lancaster General Health (Lancaster, PA)
- …NCLEX within 60 days of starting in their RN role. + A graduate registered nurse may only practice professional nursing under supervision and if the graduate ... registered nurse holds a current temporary practice permit.... nurse is practicing. + All Clinical Nurse 1 RN 's will be required to successfully… more
- AdventHealth (Hinsdale, IL)
- …resolution skills . Teamwork principles **EDUCATION AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse ( RN ) . ... documents avoidable days, and facilitates progression of care. . Collaborates with Utilization Management staff for collaboration on patient status changes and… more
- AdventHealth (Hinsdale, IL)
- …skills **.** Teamwork principles **EDUCATION AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse ( RN ) . ... documents avoidable days, and facilitates progression of care. **.** Collaborates with Utilization Management staff for collaboration on patient status changes… more
- Lancaster General Health (Lancaster, PA)
- …NCLEX within 60 days of starting in their RN role. + A graduate registered nurse may only practice professional nursing under supervision and if the graduate ... that established outcomes are achieved through availability and appropriated utilization of human, material and financial resources. + Educates...area or unit where the graduate registered nurse is practicing. + For Magnet designated RN… more
- CommonSpirit Health Mountain Region (West Jordan, UT)
- …resources to help you flourish and leaders who care about your success. As a Registered Nurse , RN Case Manager you'll advocate for patients while ... discretion, and independent judgment in assessing/reassessing, facilitating care coordination, utilization management , and patient advocacy. + Assure medical… more
- Lancaster General Health (Lancaster, PA)
- …NCLEX within 60 days of starting in their RN role. + A graduate registered nurse may only practice professional nursing under supervision and if the graduate ... that established outcomes are achieved through availability and appropriated utilization of human, material and financial resources. + Educates...area or unit where the graduate registered nurse is practicing. + For Magnet designated RN… more
- RWJBarnabas Health (Rahway, NJ)
- Per Diem Registered Nurse ( RN ), Case ManagementReq #:0000148300 Category:Nursing Status:Per Diem Shift:Day Facility:RWJ Rahway Department:Case Management ... + Successful completion of all Orientation Program Certifications and Licenses Required: + Active Registered Nurse License in the state of New Jersey + Basic… more
- Banner Health (Mesa, AZ)
- …people the tools they need to perform at their best. As a Medical/Surgical Float Registered Nurse RN you will provide patient care throughout the facility ... culture. Clinical Care Operations is the hub of patient management for the campus, including: bed assignment, unit staffing...care setting within the past 12 months as a Registered Nurse in the specialty area. Banner… more
- Catholic Health Initiatives (Houston, TX)
- … Functions and regulatory compliance for the director and department members. Registered Nurse ( RN ) is required for this position** **Responsibilities** ... Management a. Serves as a clinical resource for utilization management , compliance for the...and responsibility. **Qualifications** Required Education and Experience *Bachelor's Degree * Registered Nurse ( RN ) *Five (5)… more
- RWJBarnabas Health (Elizabeth, NJ)
- Case Manager Registered Nurse ( RN ), Case ManagementReq #:0000150517 Category:Nursing Status:Full-Time Shift:Day Facility:Trinitas Regional Medical Center ... Licenses Required: + Currently licensed to practice as a Registered Nurse in NJ + Basic Life...department and safeguards system resources by actively participating in utilization management and insurance communication. Collaborates closely… more
- Intermountain Health (Murray, UT)
- …to members and providers in accordance with notification standards. Implements utilization management processes and coordinate medical services with other ... management intervention. Perform all required documentation and entry into utilization management operating system for authorization and determination.… more