- CHRISTUS Health (San Antonio, TX)
- …for assigned areas; at CHRISTUS St. Patrick Hospital. The nurse manager affects departmental outcomes through interpretation, implementation, and evaluation ... excellence in patient care, patient experience and patient outcomes. Effectively manages utilization of staff and material resources so that the most therapeutically… more
- Conifer Revenue Cycle Solutions (Frisco, TX)
- …(2) years supervisory experience CERTIFICATES, LICENSES, REGISTRATIONS Preferred: Active state Registered Nurse license or Certified Coding Specialist credential ... drug utilization Knowledge of MS-DRG classification and reimbursement structures PC/ Systems literate including the Internet and MS office skills Ability to apply… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …(ie UM and CM). Incumbent is required to know multiple functional areas and supporting systems . + Expert in Utilization Management and ability to handle ... depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of… more
- UNC Health Care (Morrisville, NC)
- …health and well-being of the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and ... operational leader responsible for designing, implementing, and standardizing utilization management functions across a large healthcare system , including a… more
- Alameda Health System (Oakland, CA)
- …Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic ... Director, Utilization Management + Oakland, CA +...background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.… more
- AmeriHealth Caritas (Lafayette, LA)
- …in a fast-paced, high-volume utilization review environment. **Licensure:** + An active Registered Nurse ( RN ) license in Louisiana or multi state license ... **Role Overview:** Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for...managed care organization. + Proficiency in Electronic Medical Record Systems and Utilization Review Systems … more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Other duties as assigned. Essential Qualifications + Active and unrestricted license as a Registered Nurse ( RN ) + Bachelor's degree in nursing, (or ... About The Role The Manager, Utilization Management (UM) will manage the...for UM team members including Nurses and Coordinators on systems , departmental processes, and policies. + Facilitate ongoing quality… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is...player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Humana (Little Rock, AR)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
- Cleveland Clinic (Cleveland, OH)
- …+ Graduate of an accredited School of Nursing + Current state licensure as a Registered Nurse ( RN ) + Basic Life Support (BLS) Certification through the ... most respected healthcare organizations in the world. As a Utilization Management Specialist, you will perform UM...Three years of equivalent full-time clinical experience as a Registered Nurse + Analytical ability required to… more
- AnMed Health (Anderson, SC)
- …here. This position is responsible for performing the daily operations of the Utilization Management program at AnMed within the Care Coordination model. These ... necessity review, continued stay/concurrent review, retrospective review, bed status management , resource utilization management , regulatory compliance,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating care for ... benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer is...and verbal communication skills. + Proficient with multiple IT systems . + Able to identify and set goals, follow… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization ...standards + Working knowledge of CareFirst IT and Medical Management systems , familiarity with web-based software application… more
- CVS Health (Jefferson City, MO)
- …active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing… more
- CVS Health (Harrisburg, PA)
- …active current and unrestricted RN licensure in state of residence** **- Utilization Management is a 24/7 operation and work schedules will include weekends, ... all with heart, each and every day. **Position Summary** ** Utilization Management is a 24/7 operation and...**Required Qualifications** **- 2+ years of experience as a Registered Nurse in adult acute care/critical care… more
- CVS Health (Carson City, NV)
- …active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, ... day. **Must Reside in PST Time Zone** **Position Summary** Utilization Management is a 24/7 operation and...Time Zone + 2+ years of experience as a Registered Nurse in adult acute care/critical care… more
- University of Michigan (Ann Arbor, MI)
- …assigned DAILY WORK DUTIES 1. Insurance Alert Changes from software system for utilization management : notify RN CM if additional clinicals are required ... become one of the world's most distinguished academic health systems . In some way, great or small, every person...authorization numbers and approval days/dates into the appropriate software system for utilization management and… more
- Intermountain Health (Las Vegas, NV)
- …+ Continuous Improvement + Scheduling **Physical Requirements:** **Minimum Qualifications** + Current Registered Nurse ( RN ) license in state of practice ... including social work and complex care planning, transitions of care, and utilization management . The position ensures compliance with state, national, and… more
- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license,… more
- Saint Francis Health System (OK)
- …in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the details ... Nursing. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 2 years of… more
