- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- …rounds. Manage department budget, staffing, and training needs. Function as Utilization Review /Denials Manager as required. Qualifications Registered ... review , and transitions to prevent readmissions. Liaise with medical staff, utilization review , social services, payors, and community providers. Track and… more
- Novo Nordisk Inc. (Boston, MA)
- …collateral development Achieve or exceed assigned sales objectives through effective utilization of all available resources, strategies and tactics Collaborates with ... exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications A bachelors degree...this job family are as follows: Rare Endocrine Therapy Manager $ 96,670 to $ 178,840 Sr Rare Endocrine… more
- AmeriHealth Caritas Health Plan (Philadelphia, PA)
- …collaboration. Lead with Clinical Insight. Whether you're an experienced utilization review nurse, a sharp case manager , or a behavioral health clinician ... services. Discover more about us at www.amerihealthcaritas.com. Join a mission-driven Utilization Management team where your clinical expertise helps shape better… more
- MedPro Healthcare Staffing (Silver Spring, MD)
- …RN Travel, Travel Nurse, Contract Nurse, Agency Nurse, Travel Contract, Travel Nursing, Case Manager , Case Management, Utilization Review , Case Manager ... Joint Commission-certified staffing agency, is seeking a quality Case Manager Registered Nurse (RN) for a travel assignment with...months of recent experience in an Acute Care Case Manager setting Active RN License BLS Certifications Degree from… more
- Novo Nordisk Inc. (Olive Branch, MS)
- …improved patient health. Internally, the OCS reports to the District Business Manager of the specific sales territory. The OCS also interacts and collaborates ... sales and marketing resources to expand the breadth and depth of appropriate utilization Novo Nordisks products, consistent with label and company policy Analyze and… more
- Novo Nordisk Inc. (San Diego, CA)
- …the Specialty Field Sales Representative reports to the District Business Manager of the specific sales territory. The Specialty Field Sales Representative ... appropriate patients that would benefit in order to ensure early trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved… more
- Merck & Co. (Durham, NC)
- …several years; currently Durham employs 1,000+ people. This role as a Manager , Operations will be an energetic, leader with strong interpersonal, leadership, and ... culture by reducing waste and constantly driving continuous improvement. -Responsible to review and approve compliance documents, as per procedures or need.Supply -… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …a strong collaborator across MAPA and NNI, a self-starter who is self-led and keeps their manager up to date on progress and ensures no surprises and is seen as a ... their placement in the treatment continuum as well as appropriate utilization and treatment guidelines Proactively leverages detailed knowledge of all applicable… more
- American Traveler (Washington, DC)
- American Traveler is seeking an experienced RN Case Manager with a DC license and case management or utilization management background for a day shift position. ... years of recent case management experience required (will consider utilization management experience), *BLS certification required; CCM certification preferred,… more
- Riverside County, CA (Moreno Valley, CA)
- …Health System-Medical Center is seeking an Assistant Director of Case Management and Utilization Review to join our UR Case Management Department located in ... The department is looking for only option 1 (Case Manager ) experience at this time. OPTION I Education: Graduation...acute care hospital. Professional experience in case management and utilization review in a hospital is preferred.… more
- Valley Health System (Paramus, NJ)
- POSITION SUMMARY: Performs concurrent utilization review activities on all patients within the assigned caseload. Collaborates and educates the medical staff on ... appropriate utilization review guidelines and documentation in accordance with CMS regulations and Commercial payors guidelines. Monitors and intervenes on LOS,… more
- American Traveler (Boston, MA)
- American Traveler is seeking an experienced RN Case Manager with acute case management experience and an active MA RN license. Job Details *Position is based in a ... hospital setting within the case management department, *Day shift schedule from 08:00 to 16:30, five 8-hour shifts weekly, *A 20-week contract is available, with potential consideration for four 10-hour shifts for qualified candidates, *Uses Epic charting for… more
- EvergreenHealth (Kirkland, WA)
- …provides intervention to facilitate patient care in an optimal timeline. Oversees utilization review process including education, support, and training of team ... for equipment, and arrange for additional services in the community. Utilization Management/Case Management Nurses provide clinical information to our payers and… more
- Veterans Health Administration (Houston, TX)
- Summary The Registered Nurse Quality & Patient Safety Nurse Manager - Utilization Management functions as a clinical expert and is responsible and accountable ... qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: 1-3 years Utilization Management, Nurse Case Manager /Caseworker, and/or Process… more
- Franciscan Missionaries of Our Lady Health System (Baton Rouge, LA)
- Job Description The Utilization Review Nurse performs Utilization Review on all patients to ensure appropriate resource utilization , authorization of ... have been demonstrated as evidenced by annual competency check list. Documentation of all utilization review information is complete in AS 400 as evidenced by… more
- Blue Shield of California (Oakland, CA)
- …Behavioral Health Utilization Management Clinician, Experienced, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role ... Job Description Your Role The Behavioral Health Utilization Management team performs prospective & concurrent ...you will conduct clinical review of mental health and substance use authorization requests… more
- Cumberland Heights Foundation, Inc. (Nashville, TN)
- …supervision, according to organizational policy and license requirements Collaborates with internal utilization review specialists and case manager , as well ... support behavioral change toward patient's goals in establishing ongoing recovery management, including review and revision of the plan of care as needed, as well as… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- Clinical Review Manager - The BlueAdvantage Inpatient Utilization Management department is looking for an RN with at least 3 years of clinical experience to ... provider and member appeals, denial interpretation for letters, retrospective claim review , special review requests, and UM pre-certifications and appeals,… more
- PIH Health (Downey, CA)
- …from PIH Health Hospitals to the patient's contracted facility. The RN ED Access Case Manager performs utilization review with a high level of expertise by ... to the right level of care. The RN ED Access Case Manager works to ensure appropriate utilization of hospital resources in all settings and levels of care. The… more
- Central Maine Healthcare (Lewiston, ME)
- …for our community and for each other every day. Position Summary: The Utilization Management Nurse is responsible for a comprehensive clinical review to ... *Three (3) or more years of previous experience in Utilization Management and/or Care Management. *BSN preferred *Certified Case... Management and/or Care Management. *BSN preferred *Certified Case manager required within 2 years of hire. If you… more
