- CVS Health (Hoboken, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... County and surrounding counties. Position Summary This is a remote Case Manager opportunity with 50 to 75% field...Health service strategies, policies, and programs are comprised of utilization management , quality management , network… more
- 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...a resource for navigating post-acute care services. Minimum Qualifications: RN licensed by the State of Maryland or Compact… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Role The RN Utilization Management Reviewer is responsible for facilitating care for ... to provide the best quality care. The Team The RN Utilization Management Reviewer is...restrictions against a license must be disclosed and reviewed Registered nurses only, bachelor's degree in nursing (BSN) preferred… 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)
- …Management Program is responsible for the case management , care coordination management , and utilization management of his/her population of patients ... for appropriate consultations and support services within established protocols Completes Utilization Management for assigned patients. Applies Milliman Care… more
- UnitedHealth Group (Wausau, WI)
- …medical records, benefit plans, medical policies, and other various criteria Utilization Management , pre-authorization, concurrent review, or appeals experience ... RNs with solid interpersonal skills to join our team. The Clinical Appeals RN will be responsible for reviewing appeals and provider inquiries for clinical… 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 ... Owensboro, KY area. Must live locally. Position Details: Location: Hybrid- Remote . Work from home (telehealth) and travel within an...years of Case Management or Chronic Care Management 1+ years of utilization management… more
- Molina Healthcare (Long Beach, CA)
- …Practical Nurse in good standing. Preferred Education Completion of an accredited Registered Nurse ( RN ) Program or a bachelor's degree in Nursing. ... Practical Nurse (LPN) Program Required Experience Minimum two years Utilization Review experience. Knowledge of audit processes and applicable state and federal… more
- Magellan Health, Inc. (Somerset, PA)
- …- Licensed Professional Counselor - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... Seeking PA licensed candidates for this remote position in Bedford/Somerset areas, candidates need to...time management and communication skills. Knowledge of utilization management procedures, mental health and substance… more
- UnitedHealth Group (Eden Prairie, MN)
- …or Health plan 4+ years working with Medicare, Medicaid regulatory requirements with Utilization Management , Case Management or Clinical Product ... HCBS WAIVER, ABD, TANF/CHIP Promotes regulatory compliance processes and change management on all assigned programs and initiatives Participates in the development… more
- Bluestone Physician Services (Brookfield, WI)
- …with primary care teams to ensure high quality team-based care Use utilization management tools to facilitate appropriate transitional care management ... engage with providers to identify high risk patients Qualifications: Education/Certification/Experience Registered Nurse or Licensed Social Worker 3-5 years of… more
- EmblemHealth (New York, NY)
- …with current active RN license (Required) CCM certification (Preferred) Certification in utilization or care management (Preferred) 4 - 6 years of clinical ... Experience in case management /care coordination, managed care, and/or utilization management (Preferred) Strong communication skills - verbal, written,… 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...Manager is responsible for helping coordinate and evaluate the management of patients with acute and chronic conditions, across… more
- UnitedHealth Group (Eden Prairie, MN)
- …development for other roles you may be interested in. Required Qualifications: Licensed Registered Nurse 7+ years of professional experience in an acute care ... us to start Caring. Connecting. Growing together. The Advisory Director, Care Transformation - Remote will be a part of a team responsible for solving some of the… more
- Carle Health (Urbana, IL)
- …**Hybrid position with 1 day remote and 4 in office** The OP Care Management RN provides care management and population health services to patients. The ... with high vulnerability at times of transition between care settings. OP Care Management RN will coordinate care around patient's chronic diseases, coordinate… more
- Blue Cross and Blue Shield of Minnesota (St. Paul, MN)
- …difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre and ... to improve provider performance and member satisfaction. Required Skills and Experiences Registered nurse or licensed behavioral health clinician (ie LICSW,… more
- CareStar, Inc. (Caldwell, OH)
- …social work, counseling, psychology, or a related field; Licensed Social Worker (LSW) and Registered Nurse ( RN ) preferred. 12 months experience in home and ... and other resources, regardless of funding source. Approves funds for utilization of available services, while meeting all qualifications and standards as… 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 ... a defined jurisdiction. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with… more
