- UPMC (Pittsburgh, PA)
- …candidates with a Pennsylvania RN license. The Utilization Management ( UM ) Care Manager is responsible for utilization review of health plan services and ... UPMC Health Plan is hiring a full-time UM Care Manager to support our...Case management certification or approved clinical certification preferred + Registered Nurse ( RN ) + Act… more
- UCLA Health (Los Angeles, CA)
- …clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays...vital role in ensuring the delivery of high-quality, evidence-based care . This position is responsible for reviewing and evaluating… more
- Dignity Health (Bakersfield, CA)
- …experience. - Graduate of an accredited RN Program. - Clear and current CA Registered Nurse ( RN ) license. - Knowledge of nursing theory and ability to ... customer service in line with CommonSpirit's values. You will function as a UM nurse reviewer, applying clinical expertise to ensure appropriate healthcare… more
- Highmark Health (Harrisburg, PA)
- …UM /CM/QA/Managed Care + Medical/Surgical experience + Utilization Management ( UM ) or (UR) Utilization Review experience **LICENSES AND CERTIFICATIONS** ... SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services,...**Required** + Current State of PA RN licensure OR Current multi-state licensure through… more
- Health Care Service Corporation (Helena, MT)
- …health needs within the scope of their benefit plan. **Required Job Qualifications:** + Registered Nurse ( RN ) with current, valid, unrestricted license to ... **Job Summary** This position is responsible for performing concurrent review in accordance with approved departmental guidelines; performing discharge planning… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of ... First Refusal (ROFR) requests, review of Specialty Care Referrals, sustaining up-to-date Specialty Clinic Referral Review...RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : University Hospital ( PACU ) Apply Now **Mission Statement** Michigan Medicine improves the health of patients, populations and communities ... review charts for H&P, consent, etc.). Provide direct care for Pre-op patients. **Nursing Specific Info** Salary &...employer. **Job Detail** **Job Opening ID** 272177 **Working Title** REGISTERED NURSE : University Hospital ( PACU )… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE / FLIGHT NURSE SPECIALIST :...pediatric ICU (does not include Neonatal ICU) experience as a RN in a referral center / tertiary care ... Curriculum is to prepare the proficient emergency / critical care nurse for clinical practice as a...employer. **Job Detail** **Job Opening ID** 270230 **Working Title** REGISTERED NURSE / FLIGHT NURSE SPECIALIST… more
- Cedars-Sinai (Beverly Hills, CA)
- …the Los Angeles Fair Chance Initiative for Hiring. **Req ID** : 12949 **Working Title** : Registered Nurse - ISP Care Coordinator - PER_DIEM 8 Hour Days ... they are discharged from the hospital by assessing their needs, coordinating care , communicating with health plans, including concurrent review to determine… more
- Healthfirst (NY)
- …concurrent review , and service requests Lead, coach, and develop UM managers overseeing interdisciplinary teams of registered nurses, social workers, ... institution or equivalent work experience NYS RN Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care … more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE (Cardiovascular Center- CVICU-5 &...to deliver the safest and highest quality of health care . Applicants are expected to review the ... opportunity employer. **Job Detail** **Job Opening ID** 271927 **Working Title** REGISTERED NURSE (Cardiovascular Center- CVICU-5 & Telemetry) **Job Title**… more
- Katmai (Fort Carson, CO)
- …Degree of Nursing. + Current, full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate from a college or university ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management ( UM )...years within the last four (4) years as a registered nurse in utilization management. + One… more
- US Tech Solutions (Wichita, KS)
- …and implementation of QM Work Plan Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior ... CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . +... Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:**… more
- University of Miami (Miami, FL)
- …please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Registered Nurse works as a part of a ... team to provide quality care to designated patients. The RN works...are not limited to: Performance Nursing Duties as per Nurse Job Description 100% Perform patient interview and obtains… more
- ERP International (Luke AFB, AZ)
- **Overview** ERP International is seeking a full time ** Registered Nurse - Case Management** in support of the56th Medical Group at Luke AFB, AZ ... **Be the Best!** Join our team of exceptional health care professionals across the nation. Come discover the immense...full, active, and unrestricted license to practice as a Registered Nurse , any state. Clinical Certification:** Certified… more
- Lawrence General Hospital (Methuen, MA)
- Job Description: The RN Care Coordinator is responsible for overseeing the appropriateness of care provided to members of health plans contracted by the ... appropriate financial and clinical outcomes of these patients. The RN Care Coordinator will be assigned to...acute care setting with discharge planning, continuing care , care management, and utilization review… more
- University of Miami (Miami, FL)
- …not require direct physician involvement as per physician orders and within the scope of RN licensure 7. Renders dire ct patient care by assisting providers with ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Sign on Bonus:… more
- Molina Healthcare (Tacoma, WA)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- LA Care Health Plan (Los Angeles, CA)
- …for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted California ... Utilization Management Nurse Specialist RN II Job Category:...timelines as defined by the most current department policy. Facilitate/ review requests for Higher level of care … more
- Molina Healthcare (Sparks, NV)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...At least 2 years of experience with inpatient concurrent review , prior authorization and managed care ; Acute… more