- Guidehealth (Joliet, IL)
- …Join us as we put healthcare on a better path!! Job Description As a registered nurse with an Illinois nursing license, you will work remotely to enhance ... annual program requirements. Qualifications WHAT YOU'LL NEED TO HAVE Current IL Registered Nurse License (State of Illinois requires Nursing Professional Staff… more
- Trinity Health (Silver Spring, MD)
- Employment Type: Full time Shift: Day Shift Description: Job Title: RN Case Manager - Utilization Management Employment Type: Full Time Shift: Day Location : ... Cross Hospital Position Purpose: As a Case Manager in Utilization Management, you will be the key to ensuring...care and address clinical documentation needs for accurate case review and status determination. Oversee the continuity of care… more
- US Tech Solutions (Columbia, SC)
- Duration: 3+ Months Contract (Possible Extension) Job Description: Must be an RN in SC and have an active and unrestricted SC RN license. Hours/Schedule - M-F ... 8:30am - 5pm. Onsite training for the first week. Remote once training is complete. Experience: Hospital experience, UM experience. Description: Office work, at a… more
- NorthShore (Warrenville, IL)
- …(American Red Cross) is preferred. Experience: Minimum three (3) years of utilization review , discharge planning, case management or disease management ... years of experience, among other factors. Position Highlights: Position: RN Transitional Care Navigator (Population Health) - Chronic and...-5:00 pm), 2 days onsite required and 3 days remote optional. Weekend and holiday required per rotation. … more
- UnitedHealth Group (Wausau, WI)
- …medical records, benefit plans, medical policies, and other various criteria Utilization Management, pre-authorization, concurrent review , or appeals experience ... interpersonal skills to join our team. The Clinical Appeals RN will be responsible for reviewing appeals and provider...detective skills to the test as you investigate and review a variety of medical services. If you are… more
- DaVita, Inc. (Owensboro, KY)
- …AVE, OWENSBORO, Kentucky, 42303-1443, United States of America As a DaVita Integrated Kidney Care Registered Nurse ( RN ) Case Manager you will support some of ... assisting them in navigating a challenging healthcare system. Through medical record review and consultation, you will identify the medical, social, emotional, and… more
- Molina Healthcare (Long Beach, CA)
- …Licensed Practical Nurse (LPN) Program Required Experience Minimum two years Utilization Review experience. Knowledge of audit processes and applicable state ... Nurse in good standing. Preferred Education Completion of an accredited Registered Nurse ( RN ) Program or a bachelor's degree in Nursing. Preferred… more
- ECRI (Plymouth Meeting, PA)
- …365 Suite of products (eg, Word, Excel, and PowerPoint). Certifications and Licenses: Current Registered Nurse ( RN ) license preferred One or more of the ... Details Job Location Corporate Headquarters - Plymouth Meeting, PA Remote Type Fully Remote Position Type Full...Qualifications POSITION QUALIFICATIONS Experience: Five years' experience as a Registered Nurse in an acute hospital; or… more
- ArchWell Health (Tulsa, OK)
- …with bachelor's degree in a related clinical field preferred. A valid, active, unrestricted Registered Nurse ( RN ) license in State of employment required. ... and lower total cost of care. Job Summary: The Nurse Care Manager is responsible for helping coordinate and...work experience required. A minimum of 1 year of utilization review , home health, discharge planning experience… more
- Blue Cross and Blue Shield of Minnesota (St. Paul, MN)
- …to improve provider performance and member satisfaction. Required Skills and Experiences Registered nurse or licensed behavioral health clinician (ie LICSW, ... The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness...considered. 3 years of related, progressive clinical experience (ie RN or LPN to RN mix). Demonstrated… more
- Actalent (Boston, MA)
- …complying with all company policies and standards. Essential Skills Proficiency in clinical review , case management, utilization review , and utilization ... Clinical Review Clinician Job Description As a Clinical ...NCQA, Medicare, and Medicaid regulations is preferred. Familiarity with utilization management processes is preferred. State Licensure as LPN,… more
- Corvel (Folsom, CA)
- CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in Folsom, CA. Work ... in a high-volume, fast-paced, team-oriented environment. Experience as a RN , Medical Case Manager is ideal, or a clinical...advisors/clients and coworkers. A cost containment background, such as utilization review or managed care is helpful.… more
- Mindful Care (Chicago, IL)
- We are seeking Board Certified Psychiatric Mental Health Nurse Practitioners (PMHNP) to expand access to behavioral health care in your area. If you're passionate ... Completion of a Master's degree in nursing from an accredited program Active RN license within the employed state Board certification by the American Nurses… more
- University of Nebraska Medical Center (Omaha, NE)
- …experience. Required License Yes If yes, what is the required licensure/certification? Registered nurse with current licensure or licensure eligible. Required ... Full-Time Regular Work Schedule TBD by supervisor and responsibilities Remote /Telecommuting No remote /telecommuting opportunity Position Summary Coordinate… more
- Indiana University Health (Indianapolis, IN)
- …and implement creative solutions to unique or complex situations. Qualifications & Experience Active Registered Nurse ( RN ) license in the state of Indiana or ... an active Nurse Licensure Compact (NLC) RN license required. Experience in managed care, utilization review , and/or care coordination or case management… more
- Parexel (San Francisco, CA)
- Job Title: Data Management Lead (Medical Affairs) Location: Fully Remote (US based) Must be able to accommodate West Coast hours. About Us: At Parexel, we are ... research practices like version control and literate programming. BSN, RN , RPh, Pharm D, PA, MPH, or other applicable...and ensure high-quality, compliant data. Use surveillance tools to review data at an aggregate level, identifying patterns or… more
- BJC HealthCare (St. Louis, MO)
- … experience performing care for hospitalized patients. + 2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity ... team. This is a great opportunity for a local remote position. **Schedule** PRN (As needed) + Shifts will...in St. Louis. + Have both Missouri and Illinois RN licenses. + If candidate only has one … more
- Ochsner Health (New Orleans, LA)
- …case management or utilization review . **Certifications** Required - Current registered nurse license in state of practice. Basic Life Support (BLS) from ... and implement discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- CVS Health (Oklahoma City, OK)
- …contribute to improving the quality and effectiveness of healthcare services and benefit utilization . This position requires close review of both handwritten and ... and every day. **Position Summary** This is a **fully remote role** with a requirement to **reside in Oklahoma**...with a requirement to **reside in Oklahoma** . The nurse in this position uses clinical expertise in a… more
- AdventHealth (Altamonte Springs, FL)
- …injuries and rehabilitation is essential **LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED:** + Active Registered Nurse ( RN ) license in the state of ... **Location:** Remote **The role youll contribute:** A Workers Comp Support Registered Nurse is responsible for providing telephonic medical case management… more
