- UPMC (Pittsburgh, PA)
- …and Clearances:** + Case management certification or approved clinical certification preferred + Registered Nurse ( RN ) + Act 34 *Current licensure either ... Are you an experienced nurse looking for the next challenge in your...new opportunity! UPMC Health Plan is hiring a full-time Telephonic Care Manager to support the Medicare line of… more
- ChenMed (Tampa, FL)
- …+ Under the direction and supervision of a Registered Nurse ( RN ) provides in home and telephonic visits to patients at high-risk for hospital ... The Community Care team is a multidisciplinary service including Registered Nurse ( RN ) Community Care...in Case Management: + A minimum of 2 years' utilization review and/or case management, home health… more
- Sharecare (Orem, UT)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- ChenMed (North Miami Beach, FL)
- …RN with bachelor's degree in a related clinical field preferred. + A valid, active Registered Nurse ( RN ) license in State of employment required. + A ... great people to join our team. The Acute Care Nurse ( RN ) is responsible for achieving positive...patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with… more
- Matrix Providers (Fairfield, CA)
- Registered Nurse - Disease Management Location: Fairfield, CA, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... lower provider-to-patient ratios and fair, reliable schedules. Matrix Providers is hiring a Registered Nurse - Disease Management to join our team of talented… more
- CVS Health (Frankfort, KY)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... in a hospital setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- CVS Health (Charleston, WV)
- …2+ years CM, discharge planning and/or home health care coordination experience * Registered Nurse with active unrestricted state license in good standing within ... Overview** This is a Hybrid role. The Care Manager RN will be responsible to work from home as...coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes. **What… more
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- …The North Florida/South Georgia Veterans Health System (NF/SG VAHS) is recruiting for a Registered Nurse Care Coordinator to work in the Office of Community Care ... and from the community. Possesses the knowledge related to VHA guidelines, utilization review criteria, current evidence-based standards of care, compliance… more
- ERP International (Luke AFB, AZ)
- **Overview** ERP International is seeking full time ** Registered Nurse - Case Management** in support of the56th Medical Group at Luke AFB, AZ ... Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health… more
- ICW Group (Pleasanton, CA)
- …providing direct clinical care required. **CERTIFICATES, LICENSES, REGISTRATIONS** Current unrestricted Registered Nurse ( RN ) or Licensed Vocational ... evaluate needs for treatment in worker's compensation claims. The Telephonic Nurse Case Manager will negotiate and...+ Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance… more
- Access Dubuque (Dubuque, IA)
- …consumers, ensuring quality outcomes and cost-effective treatment. **Key Responsibilities:** + Provide telephonic case management and utilization review for ... Bilingual RN Case Manager **Cottingham & Butler/ SISCO** 1...Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. + **Skills:**… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4 ... and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high risk...the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- CVS Health (Doral, FL)
- …all with heart, each and every day. **Position Summary** The Care Manager RN is responsible for driving and supporting care management and care coordination ... care (assessing, planning, implementing, coordinating, monitoring, and evaluating). The CM RN utilizes advanced clinical judgment and critical thinking skills to… more
- US Tech Solutions (Columbia, SC)
- …+ Skill sets/qualities: Must have at least 2 years hospital experience, any other utilization review experience is great, different areas of work is always a ... queue they work the incoming cases out of. They review the requested procedure against the criteria we use...with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member… more
- LA Care Health Plan (Los Angeles, CA)
- …requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Utilization Management Nurse Specialist RN...Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review ,… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** The Sr Clinician, Behavioral Health Utilization Review will review behavioral health and substance use ... in behavioral health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred **Required Knowledge,… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... skills. Experience in case management or care coordination and telephonic care experience is preferred. + A typical day...the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- Albany Medical Center (Albany, NY)
- …Aids Program Work Shift: Day (United States of America) Salary Range: $60,028.00 - $99,023.00 Registered Nurse ( RN ) - Full time HIV Medicine Clinic - Albany, ... advanced practice provider (APP) and the supervision of the Nurse Manager ( RN ) and/or Nurse ...Nursing program is required* Current NYS license as a Registered Nurse Thank you for your interest… more
- ChenMed (Philadelphia, PA)
- …with bachelor's degree in home in a related clinical field preferred. + A valid, active Registered Nurse ( RN ) license in State of employment required. + A ... we need great people to join our team. The RN Case Manager (Community Care Nurse ) is...with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ;… more
- Albany Medical Center (Albany, NY)
- …Work Shift: Day (United States of America) Salary Range: $60,028.00 - $99,023.00 Registered Nurse ( RN ) - Full Time Pediatric Endocrine Department ... advanced practice provider (APP) and the supervision of the Nurse Manager ( RN ) and/or Nurse ...may provide direct patient care, patient triage (in-person and telephonic ), assessment, planning, directing and evaluating of a patient's… more
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