- Prime Healthcare (Weslaco, TX)
- …#patientrentry #patienttreatmentplan Connect With Us! (https://careers-primehealthcare.icims.com/jobs/156984/registered- nurse -case- manager utilization - ... 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
- Trinity Health (Philadelphia, PA)
- …Comments: 4 "Interviews patients/significant others within one working day of Utilization Management Nurse , ED Case Manager , Care Transition Nurse , ... 4 "Interviews patients/significant others within one working day of Utilization Management Nurse , ED Case Manager , Care Transition Nurse , or other… more
- ERP International (Tinker AFB, OK)
- …and Tasks: Duties may include but are not limited to** : Provides Utilization Management activities and functions by using MTF-specific Quality Improvement ... **Overview** ERP International, LLC is seeking a **Registered Nurse - Utilization Managment** for a...and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case… 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
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical and service authorization ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- Cedars-Sinai (Los Angeles, CA)
- …Repetitive Motions, Eye/Hand/Foot Coordination **Req ID** : 1261 **Working Title** : Registered Nurse - Utilization Management - 8 Hour Days **Department** ... **Job Description** **Job Summary: Key Job Responsibilities** The Utilization Review Case Manager validates the...: Utilization Management **Business Entity** : Cedars-Sinai Medical Center **Job Category**… more
- Glens Falls Hospital (Glens Falls, NY)
- …who work at least 30 hours per week, can be foundhere. **Job:** **Nursing - Case Management * **Title:** *Registered Nurse - Utilization Review Nurse - ... timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and… more
- CommonSpirit Health Mountain Region (West Jordan, UT)
- …discretion, and independent judgment in assessing/reassessing, facilitating care coordination, utilization management , and patient advocacy. + Assure medical ... leaders who care about your success. As a Registered Nurse , RN Case Manager you'll advocate for...**Experience Requirements** + 1 year of nursing or case management experience required. + Working knowledge of regulatory requirements… more
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** +… more
- Milford Regional Medical Center (Milford, MA)
- …with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at MRMC. The UR ... years acute or critical care experience Minimum of 1 year Nurse Case Management experience Minimum of 1 year Utilization Review Nurse Experience… 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 ... Accredited Case Manager (ACM) - American Case Management Association (ACMA); California Registered Nurse (RN)...Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager… more
- CVS Health (Columbus, OH)
- …reside in New Albany OH, Chandler AZ or High Point NC Precertification Nurse Case Manager is responsible for telephonically assessing, planning, implementing and ... coordinating all case management activities with members to evaluate the medical needs...Services strategies, policies and programs are comprised of network management and clinical coverage policies.What is A1A?Aetna One Advocate… more
- CVS Health (Raleigh, NC)
- …to office locations in New Albany OH, or High Point NC. Precertification Nurse Case Manager is responsible for telephonically assessing, planning, implementing ... and coordinating all case management activities with members to evaluate the medical needs...Services strategies, policies and programs are comprised of network management and clinical coverage policies. What is A1A?Aetna One… more
- UNC Health Care (Raleigh, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders,… more
- Centene Corporation (Austin, TX)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent...management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness ... of services as well as appropriate utilization of services; and ensuring optimum use of resources,...delivery and quality of patient care. A hospital-based case management system has as its primary goal to ensure… more
- Beth Israel Lahey Health (Burlington, MA)
- …**Scheduled Hours:** 40 **Work Shift:** Day (United States of America) Joint role of Case Manager and Utilization Review Nurse Hospital at Home Full Time ... and holiday rotations required **Job Description:** The Inpatient Registered Nurse (RN) Case Manager for Hospital at...of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience… 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
- Children's Mercy Kansas City (Kansas City, MO)
- …Responsibilities Personnel management : + Directs team members in the delivery of utilization management and care management services. + Promotes a ... children beyond the walls of our hospital. Overview The Manager of Utilization Review will provide leadership...Partners with Revenue Cycle, Payor Relations, HIM and Risk Management in support of utilization management… more