- Healthfirst (NM)
- …case management, identifying alternative care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of ... **This position is 100% Remote **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes: + Pre-certification… more
- Pacific Medical Centers (Seattle, WA)
- …patient in order to assure cost effective, appropriate utilization of health care resource. UM Nurse Case Manager perform utilization management of services ... Qualifications:** + Bachelor's Degree in Nursing. + Upon hire: Certified Case Manager . **Why Join Providence?** Our best-in-class benefits are uniquely designed… more
- Molina Healthcare (Long Beach, CA)
- …Certified Clinical Coder + Certified Medical Audit Specialists (CMAS) + Certified Case Manager (CCM) + Certified Professional Healthcare Management (CPHM) ... The **Delegation Oversight Nurse** is responsible for ensuring that Molina Healthcare's UM delegates are compliant with all applicable State, CMS, and NCQA… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …part time with full benefits with a remote work option. The Medical Director, UM is a clinical subject-matter expert for the Utilization Management Team and shall ... assist in the oversight of all UM activities. This position serves as a resource to...in areas of clinical quality, practice patterns, utilization management, case management, and patient satisfaction. This position is accountable… more
- Highmark Health (Carson City, NV)
- …industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans ... :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over… more
- Dignity Health (Glendale, CA)
- …years of nursing experience. + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification **Overview** Founded in 1926, ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (Phoenix, AZ)
- …state RN License Preferred: + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification Training: + Knowledge of managed ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...with multiple stakeholders + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (Las Vegas, NV)
- …or related healthcare field. + Certified Case Manager (CCM) Accredited Case Manager (ACM-RN) or UM Certification preferred. + Knowledge of managed ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...time management skills. + Understand how utilization management and case management programs integrate. + Knowledge of CMS standards… more
- Dignity Health (Long Beach, CA)
- …years of nursing experience. + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred + Knowledge of managed ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (Long Beach, CA)
- …(5) years of nursing experience. + Certified Case Manager (CCM) Accredited Case Manager (ACM-RN) or UM Certification preferred + Knowledge of managed ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (Carmichael, CA)
- …(5) years of nursing experience. + Certified Case Manager (CCM) Accredited Case Manager (ACM-RN) or UM Certification + Bachelor's Degree in Nursing ... clinical experience - OR - a Masters degree in Case Management or Nursing field in lieu of 1...progression of care + Understanding how utilization management and case management programs integrate + Knowledge of CMS standards… more
- Catholic Health Initiatives (Hixson, TN)
- …is required. Preferred + Certified Case Manager (CCM) Accredited Case Manager (ACM-RN) or UM Certification preferred Required Minimum Knowledge ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (San Bernardino, CA)
- …years of nursing experience. + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred + Knowledge of managed ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (Los Angeles, CA)
- …years of nursing experience. + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred + Knowledge of managed ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (Camarillo, CA)
- …(5) years of nursing experience. + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification + Knowledge of managed care ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (San Bernardino, CA)
- …years of nursing experience. + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred + Knowledge of managed ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (Los Angeles, CA)
- …(5) years of nursing experience. + Certified Case Manager (CCM) Accredited Case Manager (ACM-RN) or UM Certification preferred + Knowledge of managed ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (Santa Maria, CA)
- …years of nursing experience. + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred + Knowledge of managed ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (Oxnard, CA)
- …years of nursing experience. + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred + Knowledge of managed ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (Santa Cruz, CA)
- …and Certifications** Preferred + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred **Required Minimum ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as… more