- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- Providence Little Company of Mary Medical Center - San Pedro (San Pedro, CA)
- …Nursing Profession RN Specialty Case Manager Job ID 33531206 Job Title Registered Nurse - Case Manager @ Providence Little Company of Mary Medical ... 09/08/2025 End Date 12/08/2025 Duration 13 Week(s) Job Description Job Title: Case Manager Profession: Registered Nurse Specialty: Case Management Duration:… more
- HealthCare Support (Houston, TX)
- Utilization Review RN HealthCare Support is actively seeking a Utilization Review RN to fill an opening with a Prestigious HealthCare Company in ... Remote Houston TX . Daily Responsibilities for Utilization Review RN : WIll need...Communicates concerns that arise in these discussions to the Manager and/or Medical Director. 4. Maintains knowledge of the… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for ... Knowledge, Skills & Abilities (must have): - Expertise in managing utilization review processes including prior authorization, concurrent and retrospective… more
- Alameda Health System (San Leandro, CA)
- SLH Case Manager RN + San Leandro, CA + San Leandro Hospital + SLH Social Services + Part Time - Day + Care Management + $58.74 - $97.91 per hour + Req ... #:42605-31625 + FTE:0.7 + Posted:Today **Summary** **JOB SUMMARY** The SLH Case Manager RN is responsible for providing comprehensive case management services to… more
- Providence Little Company of Mary Medical Center San Pedro-… (San Pedro, CA)
- …assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the ... of Mary Medical Center San Pedro- Case Management Job Type Travel Offering Nursing Profession RN Specialty Case Manager Job ID 33531148 Job Title RN -… more
- Stony Brook University (Stony Brook, NY)
- RN Case Manager **Position Summary** At...the following but are not limited to:** + Completes Utilization review screen for inpatient and observation ... Stony Brook Medicine, a ** RN Case Manager ** is a valuable member of our team, who...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Stanford Health Care (Palo Alto, CA)
- …affect the processes and outcomes of patient health care **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient… more
- University Health (San Antonio, TX)
- …Staff nurse II or above). Work experience in case management, utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS Current ... POSITION SUMMARY/RESPONSIBILITIES The nurse case manager coordinates, in collaboration...licensure as a Registered Nurse with the Texas State Board...licensure as a Registered Nurse with the Texas State Board of … more
- University Health (San Antonio, TX)
- …to five years nursing experience required. Work experience in case management, utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS ... POSITION SUMMARY/RESPONSIBILITIES The nurse case manager coordinates, in collaboration...Current licensure as a Registered Nurse with the Texas State Board...Current licensure as a Registered Nurse with the Texas State Board of … more
- MVP Health Care (Schenectady, NY)
- …New York Qualifications you'll bring: Current New York State Licensure as a Registered Nurse required. Certification in Case Management required within 24 months ... functional capability through the coordination of quality cost effective care. The Case Manager will also monitor and review cases with the Medical Director… more
- Commonwealth Care Alliance (Boston, MA)
- 011150 CCA-Network Contracting **Position Summary:** The LTSS Program Manager is responsible for overseeing relationships and performance with community-based ... alignment with CCA's model of care and strategic objectives. The Manager fosters effective clinical and programmatic collaboration with provider partners,… more
- Commonwealth Care Alliance (Boston, MA)
- …Position Summary: The Behavioral Health (BH) Provider Engagement Program Manager is responsible for cultivating strong, collaborative relationships with behavioral ... mission and supporting high-quality, coordinated care for members. In this role, the Program Manager acts as an account manager , relationship manager , and… more
- University Health (San Antonio, TX)
- …recent, full time hospital experience preferred. Work experience in case management, utilization review , or hospital quality assurance experience is preferred. ... clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF...of the State of Texas to practice as a registered nurse is required. National certification in… more
- ERP International (Luke AFB, AZ)
- …and 5:00pm, including a one hour lunch **Core Duties:** - Participate in Utilization Management/Case Management meetings to review and identify opportunities to ... - Provide patient referrals. - Interface with the MTF RN Case Manager (s) in the development and...and compliance with treatment. - Participate in professional peer review case conferences, research studies, or other organizations required… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …home opportunity! Please note this position aligns to PST business hours.** The ** Manager , Case Management** Team is a Supervisor for Case Managers. This position is ... preauthorization, outpatient and inpatient management, case management, retrospective claim review , and delegated management oversight. + Participate in the… more
- Luke Staffing (Agana Heights, GU)
- …Government and professional clinical standards and clinical protocols. . Participate in Utilization Management/Case Management meetings to review and identify . ... of newly assigned unit personnel. . Collaborate in the review of unit standing operating procedures. . If directed,...services. . Provide patient referrals. Interface with the MTF RN Case Manager (s) in the development and… more
- Alameda Health System (San Leandro, CA)
- …necessarily performed by each individual in the classification. + Coordinates all utilization review functions, including response to payor requests for ... experience in Case Management in an acute setting or utilization review at a medical group or...or health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California,… more
- Commonwealth Care Alliance (Springfield, MA)
- …to influence the outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment and closing gaps in care through connecting patients ... will play an integral role supporting patients with frequent utilization of Emergency Departments and acute admissions with the...needs. This position reports to the CIC CHW Clinical Manager **Supervision Exercised:** + No, this position does not… more
- Commonwealth Care Alliance (Boston, MA)
- …administrative support of Care Delivery. programs. Under the supervision of the Manager of Patient Access Operations and in direct partnership with Care Delivery ... of patients enrolled in Care Delivery Programs The role reports to the Manager , Care Delivery Patient Access Operations Supervision Exercised: - Yes, which includes… more
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