- 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
- Penn State Health (Hershey, PA)
- …and family medical or genetic information._ \#LI-TB1 IND567 **Union:** Non Bargained **Position** Manager Utilization Management - Utilization ... OF POSITION:** Position is responsible to thoroughly understand all Utilization Management regulatory requirements for both CMS...nursing required + Currently licensed to practice as a registered nurse by Pennsylvania Board of … more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager , Utilization Management /ReviewDepartment:Patient Services-Patient Care ... a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current...preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse ( RN ) + 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 ... **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
- 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 - ... 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
- Prime Healthcare (San Dimas, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/214914/case- manager -%28rn%29 utilization - ... 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 - ... 14, 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
- Alameda Health System (Oakland, CA)
- …+ FTE:1 + Posted:July 18, 2025 **Summary** **SUMMARY:** The System Utilization Management (SUM) Care Without Delay RN is a pivotal role responsible for ... in orientation of fresh staff as requested by the Manager of Utilization Management . 17....IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- CareFirst (Baltimore, MD)
- …+ Proficient in Microsoft Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\ RN - Registered Nurse - State Licensure and/or ... week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages… more
- Commonwealth Care Alliance (Boston, MA)
- …Responsibilities: * The Utilization Management Reviewer reports to the Utilization Management Manager . * Conducts timely clinical decision review for ... facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy * Works… 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 ... degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant...admissions and short procedures by translating clinical information to Utilization Management requirements using pre ‐ determined… 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 ... communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Behavioral Health...be one of the following: + An active Licensed Registered Nurse ( RN ) in Oklahoma/multi-state,… more
- Trinity Health (Chelsea, MI)
- …**Shift:** Day 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
- 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
- LA Care Health Plan (Los Angeles, CA)
- …Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse ( RN ); current and unrestrited California License. ... Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The… more
- LifePoint Health (Hickory, NC)
- * Registered Nurse ( RN ), Clinical Case Manager * PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment ... level-of-care placement. * Uses EMR and MCG Criteria for utilization management and quality screening. * Identifies...employment." **Job:** **Nursing* **Organization:** ** **Title:** * Registered Nurse ( RN ), Clinical Case Manager … 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
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