- 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
- Tufts Medicine (Burlington, MA)
- …with the coordination of the Utilization Management Committee. The Utilization Management Operations Manager follows the system's Utilization ... day support and oversight to Utilization Review departments and UM vendor management . The UM Operations Manager is responsible for compliance with CMS… 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
- Healthfirst (IA)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
- Prime Healthcare (Weslaco, TX)
- …InterQual Criteria preferred. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/210205/registered- nurse -case- manager utilization - management ... in a related field. At least one year experience in case management , discharge planning or nursing management ;2. CCM or obtained within 6 months of hire.3.… 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)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/208989/case- manager -%28rn%29 utilization - management ... 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 - Day + Nursing + $61.76 - $102.90 + Req ... 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
- Pacific Medical Centers (Seattle, WA)
- …appropriate utilization of health care resource. UM Nurse Case Manager perform utilization management of services and coordinates the entire ... Registered Nurse License. + 5 years Clinical experience. + Utilization review/case management . **Preferred Qualifications:** + Bachelor's Degree in … 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
- Elevance Health (Miami, FL)
- **JR153784 Behavioral Health Care Manager II** The Behavioral Health Care Manager II is a utilization management role and is responsible for ... utilization management review for Behavior Analysis services. **Location** : Virtual:...a related behavioral health field or a degree in nursing , and minimum of 3 years of experience with… more
- Children's Hospital Boston (Boston, MA)
- …+ Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current Massachusetts license as a ... the concurrent review process for acute psychiatric care + Possessing experience in Utilization Management / Utilization Review + Demonstrating the ability to… more
- Penn Medicine (Philadelphia, PA)
- …their critical thinking skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, ... fearful you will miss patient contact? If so, our nurse case manager role at Penn Medicine...community resources, transportation, and quality data collection and risk management referral. + Responsibilities: Utilization management… more
- Elevance Health (Morgantown, WV)
- RN Utilization Management /Review Nurse - InPatient Medicaid (JR155056) **Location:** This position requires you to **reside in the state of West Virginia.** ... : Monday through Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review)...nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has appropriate… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Humana (Louisville, KY)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied… more
- Actalent (Sunrise, FL)
- Actalent is hiring UM nurses!Job Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization of healthcare ... Working under the general supervision of the Director and/or Manager /Supervisor of Medical Management , and in collaboration...on department activities. Essential Skills + Clinical review + Utilization review + Utilization management … more
- Houston Methodist (The Woodlands, TX)
- …eligibility for state, local, and federal programs + Progressive knowledge of utilization management , case management , performance improvement, and managed ... At Houston Methodist, the Utilization Review Nurse (URN) position is...nursing experience, which includes two years in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN -… more
- AmeriHealth Caritas (Philadelphia, PA)
- …pediatric patients in a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization. + Experience ... and unrestricted Registered Nurse licensure in Pennsylvania. + Associate Degree in Nursing . Bachelor Degree in Nursing preferred. + Minimum of 3 years of… more
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