• Kaiser Permanente (Los Angeles, CA)
    …the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning or case management. Working ... the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all… more
    Upward (07/27/25)
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  • Boston Childrens Hospital (Boston, MA)
    …experience required, pediatric experience preferred. Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. Licensure/ ... Massachusetts license as a Registered Nurse (RN) A certification as a Certified Case Manager (or other pediatric specialty certification like CPN or CCRN) is… more
    Upward (07/19/25)
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  • Valley Health System (Paramus, NJ)
    …experience in clinical nursing, minimum of 3 years in case management/ utilization . SPECIAL SKILLS: Registered Nurse , Licensed in State of New Jersey, ... POSITION SUMMARY: Performs concurrent utilization review activities on all patients within the...caseload. Collaborates and educates the medical staff on appropriate utilization review guidelines and documentation in accordance with CMS… more
    Upward (07/18/25)
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  • 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
    Upward (07/24/25)
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  • EvergreenHealth (Kirkland, WA)
    …time requirements and addresses the discharge appeal process in collaboration with the Director/ Manager and/or Social Worker/RN Case Manager . Performs other ... arrange for equipment, and arrange for additional services in the community. Utilization Management/ Case Management Nurses provide clinical information to our… more
    Upward (07/06/25)
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  • Valley Presbyterian (Los Angeles, CA)
    Job Summary: As a Registered Nurse / Case Manager , Case Management Unit, you will play a pivotal in a variety of tasks that lead to a high level of ... customer satisfaction in the most cost-effective manner. Responsible for Utilization Management, Case Management, and Discharge planning activities on designated… more
    Upward (07/30/25)
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  • HEALTH FIRST CAREERS (Melbourne, FL)
    …Education: BSN or Master's Degree in a healthcare field Certification: Current Case Manager Certification (CCM or ACM) Work Experience: Critical, Intermediate ... Job Requirements POSITION SUMMARY The Utilization Review (UR) nurse performs medical...Department Nursing Knowledge/Skills/Abilities: Current working knowledge of care transitions, utilization management, case management and managed care… more
    Upward (07/15/25)
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  • MedPro Healthcare Staffing (Greensboro, NC)
    …, Contract Nurse , Agency Nurse , Travel Contract, Travel Nursing, Case Manager , Case Management, Utilization Review, Case Manager RN ... Healthcare Staffing , a Joint Commission-certified staffing agency, is seeking a quality Case Manager Registered Nurse (RN) for a travel assignment with one… more
    Upward (07/28/25)
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  • HCA Healthcare (Corpus Christi, TX)
    Registered Nurse Case Manager PRN Do you want to join an organization that invests in you as a(an) Registered Nurse Case Manager PRN? At Corpus ... a difference. We are looking for a dedicated Registered Nurse Case Manager PRN like...patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and… more
    Upward (07/28/25)
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  • OSF HealthCare (Peoria, IL)
    …in addition to our generous Paid Time Off plans! POSITION SUMMARY: The RN Case Manager - Home Health is responsible for identifying, assessing, planning, ... implementing, monitoring and evaluating clinical outcomes, service utilization , and resource management for patients on their caseload....and resource management for patients on their caseload. The Case Manager is responsible for a scope… more
    Upward (07/29/25)
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  • Healthcare Staffing Plus (Houston, TX)
    …$10k Sign on Bonus - No relocation package JOB DESCRIPTION The purpose of the Case Manager position is to support the physician, primary medical homes, and ... management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance… more
    Upward (07/02/25)
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  • HCA Florida North Florida Hospital (Gainesville, FL)
    …Name HCA Florida North Florida Hospital Job Type Permanent Offering Nursing Profession Registered Nurse Specialty Case Manager Job ID 16665674 Job Title ... Registered Nurse - Case Manager Shift Details Shift 10hr Rotating...and understand the medical needs for patients Certification in Case Management, Nursing or Utilization Review is… more
    Upward (07/23/25)
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  • Lifepoint Health (Johnstown, PA)
    Description Registered Nurse (RN), Case Manager Job Type: Full-time |M-F 8a-430pm, rotating Saturdays and On-call Department/Unit Summary Case Management ... the care of hospitalized patients. Our team of RN Case Managers, Social Workers, Utilization Review staff,...an employee, but as a person. As a registered nurse (RN) joining our team, you're embracing a vital… more
    Upward (07/25/25)
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  • Kaiser Permanente (Pleasanton, CA)
    …Quality Standards; Quality Assurance and Effectiveness; Community Health Preferred Qualifications: Certified Case Manager (CCM) in the state where care is ... managers, care managers, social workers, and/or internal/external resources as appropriate; utilization management for internal case management post acute care… more
    Upward (07/20/25)
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  • HCA Healthcare (Asheville, NC)
    …Are you passionate about delivering patient-centered care? Submit your application for Case Management Registered Nurse position and spend more time at ... supporting a balance of optimal care and appropriate resource utilization . What qualifications you will need: Required Experience: 2...in your career! We are interviewing candidates for our Case Management Registered Nurse opening. Apply today… more
    Upward (07/25/25)
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  • NavitsPartners (Boston, MA)
    …in Case Management for a 13-week travel assignment in Hyannis, MA. The Case Manager will coordinate and facilitate patient care across the continuum to ... Job Title: Travel - Registered Nurse (RN) - Case Management Location:...or financial needs and refer to appropriate resources Perform utilization reviews and respond to third-party payers with timely,… more
    Upward (07/17/25)
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  • D-H Lebanon-MHMH (Lebanon, NH)
    …standards and protocols designed to enhance quality and promote cost-effective utilization of healthcare resources. Responsibilities Facilitates the development of a ... other members of the healthcare teams questions that are within a registered nurse 's scope of practice. Communicates information to the health care team and those… more
    Upward (07/18/25)
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  • WVU Medicine (Uniontown, PA)
    …targeted patient populations. Performs resource management, including denial management, utilization management, access to the appropriate level of care, discharge ... appropriate state board where services will be provided, as a registered professional nurse OR Current multi-state licensure through the enhanced Nurse Licensure… more
    Upward (07/17/25)
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  • Fort Duncan Regional Medical Center (Eagle Pass, TX)
    …budget, staffing, and training needs. Function as Utilization Review/Denials Manager as required. Qualifications Registered Nurse (RN) with a Texas ... certification (CCM, ACM, CCM-RN) preferred. Proven leadership experience in acute care, utilization review, case management. Strong working knowledge of hospital… more
    Upward (07/13/25)
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  • NavitsPartners (Hyannis, MA)
    …Summary: We are seeking an experienced and detail-oriented Travel RN - Case Manager to support care coordination and utilization review in an acute care ... Job Title: Travel Registered Nurse (RN) - Case Management Location:...notices, facilitate appeal processes, and manage reinstatement letters Perform utilization reviews and liaise with third-party payers Coordinate discharge… more
    Upward (07/18/25)
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