- 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 ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management /Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN)...skills. Computer literacy and adaptability to computer learning. Time management and priority setting skills. Must be organized and… more
- BayCare Health System (Cotton Plant, AR)
- …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and ... compassionate team. **The Utilization Review Specialist Senior responsibilities include:** +...Nursing RN. **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management ) +… more
- Munson Healthcare (Traverse City, MI)
- …of resources. + Assists in developing and revising policies to support utilization management activities, including criteria and guidelines for appropriate use ... colleagues and hospital associates at information meetings. + May represent Utilization Management on various committees, professional organizations, physician… more
- Vanderbilt University Medical Center (Nashville, TN)
- …programs in patient care, education, and research. **Organization:** Pediatric Utilization Mgmt **Job Summary:** JOB SUMMARY Facilitates optimal reimbursement ... appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review when… more
- Sanford Health (SD)
- …Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to ... utilization and potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality of care for… more
- MyFlorida (Marianna, FL)
- REGISTERED NURSE SPECIALIST - 67039438 (SUNLAND NURSING - DAY SHIFT) Date: Apr 23, 2024 Location: MARIANNA, FL, US, 32446 MARIANNA, FL, US, 32447 MARIANNA, FL, ... Requisition No: 818010 Agency: Agency for Persons with Disabilities Working Title: REGISTERED NURSE SPECIALIST - 67039438 (SUNLAND NURSING - DAY SHIFT) Pay Plan:… more
- Trinity Health (Ann Arbor, MI)
- …Type:** Full time **Shift:** Day Shift **Description:** Exceptional opportunity for a **Clinical Nurse Specialist ** to support our vision and serve with us as ... a compassionate and transforming healing presence in our community. The Clinical Nurse Specialist (CNS) functions as an advanced practice registered nurse … more
- YesCare Corp (Brentwood, TN)
- …Veterans_ _._ **Responsibilities** Below is a list of your responsibilities as a ** Utilization Management Specialist 2** with YesCare : + Responsible ... **Experience & Requirements** + Experience Level: 3 - 5 year's experience in utilization management , case management , quality management . Experience with… more
- MyFlorida (Gainesville, FL)
- REGISTERED NURSE SPECIALIST -F/C - 60005472 Date: Apr 16, 2024 Location: GAINESVILLE, FL, US, 32641 The State Personnel System is an E-Verify employer. For more ... Requisition No: 797758 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST -F/C - 60005472 Position Number: 60005472 Salary:… more
- MyFlorida (Gainesville, FL)
- REGISTERED NURSE SPECIALIST -F/C OPS - 60957239 Date: Dec 17, 2023 Location: GAINESVILLE, FL, US, 32641 The State Personnel System is an E-Verify employer. For ... No: 815370 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST -F/C OPS - 60957239 Position Number:...knowledgeable of and utilize the principles of Total Quality Management . The employee in this position spends a minimum… more
- United Therapeutics (CA)
- …and pulmonary diseases, and other orphan diseases. **How you'll contribute** The Regional Nurse Specialist (RNS) is an educational resource deployed to help ... with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was… more
- MyFlorida (Macclenny, FL)
- REGISTERED NURSE SPECIALIST OPS - 60955422 Date: Apr 4, 2024 Location: MACCLENNY, FL, US, 32063 The State Personnel System is an E-Verify employer. For more ... . Requisition No: 772103 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST OPS - 60955422 Position Number: 60955422 Salary: $45.00… more
- Bon Secours Mercy Health (Richmond, VA)
- …Masters degree from an accredited school of Nursing. + Currently registered as a Clinical Nurse Specialist , licensed as a Nurse Practitioner or eligible to ... excellence. Job Description **Primary Function/General Purpose of Position** The Advanced Practice Nurse (APN) at St. Mary's Hospital is a professional nurse … more
- AdventHealth (Orlando, FL)
- …125,000 outpatients each year **The role you'll contribute:** **The Care Transitions Registered Nurse ensures that a care plan is carried out in partnership with the ... various other teams, including but not limited to Care Management nurses and social workers, nursing, home care liaisons,...high risk for readmission or for high emergency room utilization . Follows up with patients at location of post… more
- Trinity Health (Grand Rapids, MI)
- …of patient care related to clinical care, patient safety and resource utilization outcomes. Works with cross functional teams to improve process and outcomes ... Experience in an acute care setting. Three years in quality management and application of quality improvement methodologies, tools, standards and guidelines… more
- Ascension Health (Indianapolis, IN)
- **Details** + **Department:** Utilization Management + **Schedule:** Full time, Mon-Fri 8am-5pm + **Hospital:** Ascension St Vincent + **Location:** Remote Must ... with your Talent Advisor for additional specifics._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing… more
- Universal Health Services (Newark, DE)
- …Rockford Center is searching for a talented and patient centric Utilization Review Specialist ! Key Responsibilities include: + Completes pre-certs ... facility in DE, offers an experienced and tenured senior management team, and serves New Castle County and northern...UR Worksheets and treatment team notes. Benefits for a Utilization Review Specialist include: + Challenging and… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... Resource Management issues, other issues including concerns involving under/over utilization , avoidable days and quality issues. 13. Responsible for all incoming… more
- LA Care Health Plan (Los Angeles, CA)
- …the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and ... Enhanced Care Management Clinical Specialist II (RN or... Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer:… more