• Registered Nurse Case Manager

    Prime Healthcare (Weslaco, TX)
    …and InterQual Criteria preferred. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/210205/registered- nurse - case - manager utilization ... Bachelor degree in a related field. At least one year experience in case management, discharge planning or nursing management;2. CCM or obtained within 6 months… more
    Prime Healthcare (06/06/25)
    - Save Job - Related Jobs - Block Source
  • RN Pre Certification Case Manager

    Penn Medicine (Philadelphia, PA)
    …Registered Nurse - PA (Required) + 5yrs prior experience as a Nurse Case Manager with knowledge of utilization review and 3rd Party Payors (Required) ... Nursing Equivalent Experience: *And 5+ years Prior experience as a nurse case manager with knowledge of utilization review and third party payors. We… more
    Penn Medicine (06/05/25)
    - Save Job - Related Jobs - Block Source
  • UM Care Manager RN - Usfhp

    Pacific Medical Centers (Seattle, WA)
    …order to assure cost effective, appropriate utilization of health care resource. UM Nurse Case Manager perform utilization management of services and ... Registered Nurse License. + 5 years Clinical experience. + Utilization review/ case management. **Preferred Qualifications:** + Bachelor's Degree in Nursing.… more
    Pacific Medical Centers (05/22/25)
    - Save Job - Related Jobs - Block Source
  • RN Case Manager

    Trinity Health (Hartford, CT)
    …**Keywords: Case Management; Case Manager ; Registered Nurse ; RN; BSN; Connecticut; utilization management** **Our Commitment to Diversity and ... well-being. **What you will do:** + As a **Registered Nurse RN Case Manager Department,**...of Care including an understanding of nationally recognized medical utilization criteria, HCFA/OBRA and state of Connecticut regulatory compliance… more
    Trinity Health (04/24/25)
    - Save Job - Related Jobs - Block Source
  • Case Manager Utilization

    Beth Israel Lahey Health (Burlington, MA)
    …you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ... Nurse (RN) Case Manager for Hospital at Home Care...effectively with medical and hospital staffs. - Case Manager experience as well as Utilization Review… more
    Beth Israel Lahey Health (05/11/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Review Case

    Dartmouth Health (White River Junction, VT)
    Manager – Home Health PRN, Days Why work as a Utilization Review Case Manager at Visiting Nurse and Hospice for Vermont and New Hampshire? * You ... one 4-hour flex shift to be discussed with hiring manager . Locations: * Fully remote work in all statesexcept:...that enrich the lives of the people we serve. Utilization Review Case Managersat VNH focus on… more
    Dartmouth Health (06/06/25)
    - Save Job - Related Jobs - Block Source
  • Case Manager and Utilization

    Scottish Rite for Children (Dallas, TX)
    …one priority! We're committed to giving children back their childhood! Job Posting Title: Case Manager and Utilization Review Coordinator Location: Dallas - ... effective communication with patient care team members related to utilization management + Verify medical necessity of all Inpatients...+ Minimum 2 years of precertification experience + Certified Case Manager , preferred + 3-5 years of… more
    Scottish Rite for Children (05/23/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Review Nurse - Emergency…

    Houston Methodist (The Woodlands, TX)
    …plan of care and ensures prompt notification of any denials to the appropriate case manager , denials, and pre-bill team members, as well as management. **PEOPLE ... At Houston Methodist, the Utilization Review Nurse (URN) position is...Manages assigned patients and communicates and collaborates with the case manager to assist with appropriate interventions… more
    Houston Methodist (06/06/25)
    - Save Job - Related Jobs - Block Source
  • Case Manager , RN…

    Prime Healthcare (Lynwood, CA)
    …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209331/ case - manager %2c-rn utilization ... accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum...Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care… more
    Prime Healthcare (06/11/25)
    - Save Job - Related Jobs - Block Source
  • Case Manager (RN)…

    Prime Healthcare (Montclair, CA)
    …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/208989/ case - manager -%28rn%29 utilization ... accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum...Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care… more
    Prime Healthcare (05/28/25)
    - Save Job - Related Jobs - Block Source
  • Acute Care Case Manager , Registered…

    ChenMed (North Miami Beach, FL)
    …centers into acute and post-acute facilities, as well as, their home environments. The Nurse Case Manager 1 (RN) role also involves establishing ... of communication. + Introduces self to patient/family and explains Nurse Case Manager 's role and...experience required. + A minimum of 1 year of utilization review and/or case management, home health,… more
    ChenMed (05/28/25)
    - Save Job - Related Jobs - Block Source
  • RN Utilization Management/Review…

    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.** ... **Work Hours** : Monday through Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review) is responsible for review of the most… more
    Elevance Health (06/11/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Management Nurse

    LA Care Health Plan (Los Angeles, CA)
    …Active, current and unrestricted California License Licenses/Certifications Preferred Certified Case Manager (CCM) Required Training Physical Requirements Light ... Utilization Management Nurse Specialist RN II...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews… more
    LA Care Health Plan (06/13/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Review Nurse

    University of Utah Health (Salt Lake City, UT)
    …members or third-party payer. + Alerts and discusses with physician/provider and case manager /discharge planner when patient no longer meets medical necessity ... case that surpasses expected LOS, expected cost, or over/under- utilization of resources. + Performs verbal/fax clinical review with...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
    University of Utah Health (05/30/25)
    - Save Job - Related Jobs - Block Source
  • Registered Nurse Case Manager

    The Arora Group (Bethesda, MD)
    Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse (RN) Case Manager to work the Directorate of Healthcare ... provided one month in advance. DUTIES OF THE REGISTERED NURSE CASE MANAGER (RN): The...(RN-NCM) + National Academy of Certified Care Managers: Care Manager Certified (CMC) + Experience: + Referral Management/ Utilization more
    The Arora Group (03/27/25)
    - Save Job - Related Jobs - Block Source
  • Hybrid Utilization Management Nurse

    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 with an...education + Valid Florida Driver's License + Knowledge of case management and utilization review concepts +… more
    Actalent (06/11/25)
    - Save Job - Related Jobs - Block Source
  • Nurse Utilization Management…

    Commonwealth Care Alliance (Boston, MA)
    013650 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 a key...RN **Desired Licensing (nice to have):** + CCM (Certified Case Manager ) **Required Experience (must have):** +… more
    Commonwealth Care Alliance (05/23/25)
    - Save Job - Related Jobs - Block Source
  • Registered Nurse - Case

    WellSpan Health (Lebanon, PA)
    …2 week pay period **General Summary** Performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of ... to address patient discharge needs. Provides leadership in the integration of utilization and case management principles. **Duties and Responsibilities** +… more
    WellSpan Health (05/31/25)
    - Save Job - Related Jobs - Block Source
  • Acute Nurse Case Manager (RN)

    ChenMed (St. Louis, MO)
    …ADLs, caregiver availability) + Facilitates the discharge plan in coordination with the hospital case manager , insurance case manager , social worker and ... the patient/caregiver, hospital staff. + Identifies patients for Community Case Manager or disease management (DM) programs...experience required + A minimum of 1 year of utilization review and/or case management, home health,… more
    ChenMed (03/25/25)
    - Save Job - Related Jobs - Block Source