- 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
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time **Shift:** ... : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management , you...resource for navigating post-acute care services. **Minimum Qualifications:** + RN licensed by the State of Maryland or Compact… more
- Tufts Medicine (Burlington, MA)
- …with the coordination of the Utilization Management Committee. The Utilization Management Operations Manager follows the system's Utilization ... to Utilization Review departments and UM vendor management . The UM Operations Manager is responsible...and ensuring optimum outcomes. **Job Description** **Minimum Qualifications:** 1. Registered Nurse (BSN or higher) or other… 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 ... **Join Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff… 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
- Prime Healthcare (Weslaco, TX)
- …and InterQual Criteria preferred. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/210205/ registered - nurse -case- manager utilization - ... Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to the… 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
- 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 ... an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day ... 15, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN ...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… 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 ... Nurse License. + 5 years Clinical experience. + Utilization review/case management . **Preferred Qualifications:** + Bachelor's Degree in Nursing.… more
- Trinity Health (Chelsea, MI)
- …**Shift:** Rotating Shift **Description:** ** Registered Nurse ** **Case Manager ** **Department:** Utilization Management **Location:** Chelsea, MI ... **Minimum pay rate:** $38.77-52.32/hr + based upon RN license date and applicable experience **Why Join Us?**...+ Tuition Reimbursement **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to… more
- RWJBarnabas Health (Livingston, NJ)
- Case Manager Registered Nurse ( RN ), Case Management (per diem)Req #:0000191479 Category:Nursing Status:Per Diem Shift:Day Facility:Cooperman Barnabas ... Job Title: Case Manager Registered Nurse ( RN ), Case Management (per...setting + Minimum of one year experience in Case Management / Utilization Management or Home Care… more
- RWJBarnabas Health (Rahway, NJ)
- Per Diem Case Manager Registered Nurse ( RN ), Case ManagementReq #:0000183145 Category:Nursing Status:Per Diem Shift:Day Facility:RWJ Rahway ... all Orientation Programs Certifications and Licenses Required: + Current Registered Nurse License in the state of...and continued stay denials, improves efficiency, quality, and resource utilization . The Case Manager RN … more
- The Arora Group (Bethesda, MD)
- Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse ( RN ) Case Manager to work the Directorate of Healthcare ... month in advance. DUTIES OF THE REGISTERED NURSE CASE MANAGER ( RN ): The... Manager Certified (CMC) + Experience: + Referral Management / Utilization Management (RM/UM) experience. +… more
- AdventHealth (La Grange, IL)
- …resolution skills . Teamwork principles **EDUCATION AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse ( RN ) . ... safe transitions, patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the… more
- HCA Healthcare (Webster, TX)
- **Description** **Introduction** Do you have the PRN career opportunities as a(an) Registered Nurse RN Case Manager PRN you want with your current ... you want to work as a(an) Registered Nurse RN Case Manager PRN...utilization **What qualifications you will need:** + Current Registered Nurse License in the State of… more
- Mayo Clinic (Rochester, MN)
- …rounds and collaborates to potentially impact length of stay. The Registered Nurse ( RN ) Case Manager works within an interdisciplinary team to ... utilization management , care coordination, resource utilization , and clinical documentation. The RN Case... Manager provides leadership through education on case management / utilization management concepts, committee work,… more
- Humana (Louisville, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Registered Nurse or Social Worker Care Manager is responsible for coordinating the complex ... the continuum of care. Also works with the providers, registered nurse care managers, social workers, and...limited to: RN care managers, assistants, coordinators, utilization management staff, and director. + Facilitates… more
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