• UM Care Manager (RN) - Primarily…

    UPMC (Pittsburgh, PA)
    …a retirement plan, paid time off, life insurance, and more! The Utilization Management ( UM ) Care Manager is responsible for utilization review ... you an experienced nurse with an interest in care management ? Do you need a schedule that allows you...opportunity! UPMC Health Plan is hiring a flexible full-time UM Care Manager to support our inpatient… more
    UPMC (03/14/24)
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  • Medical Management Nurse Senior- UM

    Ventura County (Ventura, CA)
    …full-time vacancies.) There are currently four (4) Regular full-time vacancies. One (1) within Utilization Management ( UM ), one (1) within Case Management ... Medical Management Nurse Senior- UM , CM/DM, &/or QA...that they will provide Care/Case management , Disease Management , Wellness and Prevention, Utilization Management more
    Ventura County (02/17/24)
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  • Supervisor UM Review

    AmeriHealth Caritas (Palm Beach Gardens, FL)
    …**MUST BE A FLORIDA RESIDENT** **Responsibilities:** Under the supervision of the Manager for Utilization Management , this position is responsible ... UM Nurses, UM Technicians and staff members within Utilization Management . Responsibilities include providing clinical, technical and operational support… more
    AmeriHealth Caritas (02/07/24)
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  • UM Nurse Medical Management II

    Elevance Health (Denver, CO)
    …States. + Requires minimum of 3 years acute care clinical experience or case management , utilization management or managed care experience; or any ... you for payment as part of consideration for employment. ** UM Nurse Medical Management II** + Job...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
    Elevance Health (03/23/24)
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  • UM Nurse Specialist

    YesCare Corp (Brentwood, TN)
    …and document any issues relating to the outpatient/inpatient UM process to the Manager of Utilization Management . + Assist with the data collection and ... + Experience Level: 3 - 5 year's experience in utilization management , case management , quality...development, implementation, evaluation and reporting. + Work with other UM inpatient and outpatient nurse reviewers to assure proper… more
    YesCare Corp (03/23/24)
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  • RN Case Manager - UM - PRN

    LifePoint Health (Las Cruces, NM)
    …utilizes hospital resources in the development of care, discharge planning and Utilization Review. * Utilization Management performs prospective, admissions, ... observation and concurrent review according to standard policies and procedure. * Utilization Management reviews and analyze processes designed to ensure… more
    LifePoint Health (03/28/24)
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  • Supervisor, Utilization Management

    LA Care Health Plan (Los Angeles, CA)
    …the safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day ... Supervisor, Utilization Management RN Job Category: Clinical...LA Care's culturally diverse membership. The position supports the UM Manager /Director. This role also assists … more
    LA Care Health Plan (03/27/24)
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  • RN Supervisor Utilization Management

    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 ... Five or more (5+) year's clinical experience required. - Three to five (3-5) years Utilization Management ( UM ) experience required. - One to three (1-3)… more
    Dignity Health (02/22/24)
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  • RN Manager , Healthcare Services…

    Molina Healthcare (Las Vegas, NV)
    **JOB FUNCTION: UTILIZATION MANAGEMENT , REGISTERED NURSE MANAGER HEALTHCARE SERVICES** **For this role we are seeking a people leader with prior experience ... performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.),… more
    Molina Healthcare (02/11/24)
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  • Senior Utilization Management

    Providence (Anaheim, CA)
    …responsibility of the position is to maintain standard compliance and performance related utilization management data. Process of daily, weekly and monthly UM ... forth by NCQA. Acts as a resource for all UM Staff and supports UM Regional Compliance Manager and Supervisor with the execution of daily work. Providence… more
    Providence (03/14/24)
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  • Utilization Management Nurse…

    LA Care Health Plan (Los Angeles, CA)
    Utilization Management Nurse Specialist LVN II...and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case ... Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US,...in the department's continuous quality improvement activities. Communicates to UM Manager and supervising RN, barriers to… more
    LA Care Health Plan (03/12/24)
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  • Supervisor Long Term Services & Support…

    AmeriHealth Caritas (Philadelphia, PA)
    …Discover more about us at www.amerihealthcaritas.com. Under the supervision of the LTSS Manager for Utilization Management , this position is responsible for ... **Supervisor Long Term Services & Support Utilization Management Review** Location: Philadelphia, PA...providing daily oversight of LTSS Review UM Nurses, LTSS Review UM Technicians and… more
    AmeriHealth Caritas (03/23/24)
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  • Utilization Management

    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 ... to plan, execute, and manage various initiatives related to UM administrative, operational, and strategic objectives. You'll demonstrate leadership...(BSN) degree required * Five or more years of utilization management required * Four or more… more
    UCLA Health (02/23/24)
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  • Utilization Management Admissions…

    LA Care Health Plan (Los Angeles, CA)
    …and to support the safety net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II is primarily responsible ... level of care (inpatient vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on… more
    LA Care Health Plan (03/02/24)
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  • Manager , Utilization

    Martin's Point Health Care (Portland, ME)
    …has been certified as a "Great Place to Work" since 2015. Position Summary The Manager Utilization Review is responsible for oversight of utilization review ... monitors program evaluation metrics and measurements to ensure that targeted utilization management interventions remain relevant and appropriate. + Ensures… more
    Martin's Point Health Care (03/07/24)
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  • Manager I, Utilization Review…

    Elevance Health (Winston Salem, NC)
    …send you a check, or ask you for payment as part of consideration for employment. ** Manager I, Utilization Review Management ** + Job Family: Customer Care + ... Date:Mar 29, 2024 + Reference: JR109280 **Location:** + NC, WINSTON **Description** ** Manager I, Utilization Review Management ** **Location: Candidates must… more
    Elevance Health (03/20/24)
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  • Manager - Utilization

    Humana (Frankfort, KY)
    …a part of our caring community and help us put health first** The Manager , Utilization Management Behavioral Health utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Behavioral Health works within… more
    Humana (03/22/24)
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  • Registered Nurse- Utilization

    EM Key Solutions, Inc. (Eglin AFB, FL)
    Eglin AFB, FL, USA | Full Time Registered Nurse - Utilization Manager Onsite Position EM Key Solutions is seeking Registered Nurse (RN) for a full-time ... are not limited to the following: + Develops and implements a comprehensive Utilization Management plan/program in accordance with the facility's goals and… more
    EM Key Solutions, Inc. (02/14/24)
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  • Integrated Care Management Assistant…

    McLaren Health Care (Detroit, MI)
    **Position Summary:** Responsible for providing assistance to the Utilization Manager ( UM ) RN in the coordination of patient admission and continued stay ... observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more
    McLaren Health Care (01/17/24)
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  • Utilization Management RN

    Fallon Health (Worcester, MA)
    …a Registered Nurse in a clinical setting required. + 2 years' experience as a Utilization Management nurse in a managed care payer preferred. + One year ... **Overview** **The UM RN (Utlilization Management RN) will...Manager + Refers high-risk cases to the Case Management Department, Government Services Clinical Programs, Fallon Clinic Care… more
    Fallon Health (03/13/24)
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