- Commonwealth Care Alliance (Boston, MA)
- …services, procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and ... managing the daily operation of the Utilization Management Review Nurse and...decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to… more
- Penn State Health (Hershey, PA)
- …status, and family medical or genetic information._ \#LI-TB1 **Union:** Non Bargained **Position** Manager Utilization Management - Utilization ... **SUMMARY OF POSITION:** Position is responsible to thoroughly understand all Utilization Management regulatory requirements for both CMS and DOH,… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager , Utilization Management /ReviewDepartment:Patient Services-Patient Care ... + Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current Massachusetts license as a… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager...+ Current MA RN Licensure required; Bachelor's degree in nursing , health care administration or related field preferred or… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... compliance reviews as needed. + Continuously monitors regulatory requirements for Utilization Management . + Attends Mandatory Education programs required by… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- Prime Healthcare (Montclair, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/215040/case- manager -%28rn%29 utilization - ... years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse ...experience preferred. At least one year experience in case management , discharge planning or nursing management… more
- Prime Healthcare (San Dimas, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/214914/case- manager -%28rn%29 utilization - ... years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse ...experience preferred. At least one year experience in case management , discharge planning or nursing management… more
- Alameda Health System (Oakland, CA)
- …Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Evening + Nursing + Req #:41910-31048 + FTE:1 + ... in orientation of fresh staff as requested by the Manager of Utilization Management . 17....QUALIFICATIONS:** Required Education: BSN from an accredited school of nursing Preferred Education: Master's degree in nursing … more
- Alameda Health System (Oakland, CA)
- …requirements. 16. Participate in orientation of fresh staff as requested by the Manager of Utilization Management . 17. Maintains knowledge of current ... System Utilization Management SUM Specialist + Oakland,...QUALIFICATIONS:** Required Education: BSN from an accredited school of nursing Preferred Education: Master's degree in nursing … more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... in standard medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care. + Knowledge of… more
- Humana (Oklahoma City, OK)
- …a part of our caring community and help us put health first** The Manager , Utilization Management Behavioral Health utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Behavioral Health works within… more
- Guthrie (Troy, PA)
- …approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of ... Arts (BA) degree in addition to a degree in Nursing . A registered nurse with five (5)...admissions and short procedures by translating clinical information to Utilization Management requirements using pre ‐ determined… more
- Providence (Anchorage, AK)
- **Description** The Inpatient Registered Nurse (RN) Care Manager provides professional, comprehensive, patient centric care management services for at risk ... Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review, discharge planning, documentation… more
- Access Dubuque (Dubuque, IA)
- …TH Comments **Similar Jobs** Assistant Store Manager Kwik Stop Kwik Stop Utilization Management CNA Cottingham & Butler/ SISCO Entry Level Sales Executive - ... Utilization Management Assistant **Cottingham & Butler/...will also triage the call to determine if a Utilization Review Nurse is needed to complete… more
- Trinity Health (Chelsea, MI)
- …Part time **Shift:** Day Shift **Description:** **Registered Nurse ** **Case Manager ** **Department:** Utilization Management **Location:** Chelsea, MI ... Trinity Health + Tuition Reimbursement **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to support our vision and serve with us… more
- Trinity Health (Chelsea, MI)
- …time **Shift:** Rotating Shift **Description:** **Registered Nurse ** **Case Manager ** **Department:** Utilization Management **Location:** Chelsea, MI ... Trinity Health + Tuition Reimbursement **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to support our vision and serve with us… more
- LA Care Health Plan (Los Angeles, CA)
- …Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range ... the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and… more
- Community Health Systems (Gadsden, AL)
- …role **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities under ... Join us as a **Care Manager - LPN** position at Gadsden Regional Medical...clinical nursing experience required + Experience in utilization review, case management , or discharge planning… more
- Community Health Systems (Bentonville, AR)
- …live! **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities under ... the supervision of a Registered Nurse or physician. This role involves reviewing medical records...clinical nursing experience required + Experience in utilization review, case management , or discharge planning… more
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