- McLaren Health Care (Pontiac, MI)
- …12. Performs other duties as assigned. #LI-KH1 _Required_ + State licensure as a Registered Nurse ( RN ) + Bachelor's degree in nursing from accredited ... needs in EMR for continued communication with ICM UM RN and Care Management staff 7. Assesses...years of acute hospital care experience + Two years utilization and/or case management experience… more
- WellSpan Health (York, PA)
- …WellSpan's geographic footprint._** **General Summary** Performs a variety of reviews and applies utilization and case management techniques to determine the ... + 3 years Relevant experience. Required + Experience in utilization management , case management...administration or management . Preferred **Licenses:** + Licensed Registered Nurse Upon Hire Required or +… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time ... **Location** : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management ,...resource for navigating post-acute care services. **Minimum Qualifications:** + RN licensed by the State of Maryland or Compact… more
- Mount Sinai Health System (New York, NY)
- …assure timely and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care ... degree preferred + 5 years of Case Management and 6 years as a clinical nurse...New York State + Certification in case management is preferred Non-Bargaining Unit, BEZ - Utilization… more
- Aspen Medical (Aurora, CO)
- JOB AD: Registered Nurse - Utilization Management Introduction : Aspen Medical has an exciting opportunity for Registered Nurses to partner with us in ... patient care clinical setting. Must have utilization management , utilization review or case ...full, active, and unrestricted license to practice as a Registered Nurse as required in the 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 ... Job Title: Case Manager Registered Nurse ( RN ), Case Management...hospital setting + Minimum of one year experience in Case Management / Utilization Management … 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
- Beth Israel Lahey Health (Burlington, MA)
- … Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse ( RN ) Case Manager for Hospital at Home Care ... a timely process. Registered Nurses (RNs) with utilization review experience, case management ...the needs of the department. **Minimum Qualifications:** Education: * Registered Nurse , Bachelors Degree or commensurate experience… more
- R1 RCM (Boise, ID)
- …role, you must have experience in a clinical inpatient environment and hospital-based utilization or case management experience. Proficiency in basic ... analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Author** , you will help our hospital...other opportunities that promote growth. **Required Skills:** + Active Registered Nurse ( RN ) license in… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN ...an acute hospital setting. At least 2 years of Utilization Management / Case Management ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Brockton Hospital (Brockton, MA)
- …while optimizing resource utilization . Provides training to staff on case management methods and techniques. Establishes monitoring mechanisms to identify ... and develops reports that clearly monitor all areas of utilization / case management . Provides data, guidance...RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse , Revenue Integrity & Utilization Management Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant ... by Forbes as a Best Employer. Position Summary: The RN Utilization Management I will...word and excel. Licensure Requirements: Current licensure as a Registered Nurse ( RN ) as issued… more
- Houston Methodist (The Woodlands, TX)
- …two years in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure - ... Review Nurse (URN) position is a licensed registered nurse ( RN ) who comprehensively...state, local, and federal programs + Progressive knowledge of utilization management , case management… more
- Prime Healthcare (Ontario, CA)
- …or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan + ... Applicants:https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Corporate Director of Clinical Utilization Management (UM) provides comprehensive… more
- Trinity Health (Columbus, OH)
- …of the Sr. Director of Medical Management . + Coordinates with the utilization review, case management , discharge planning staff within network ... Licensure / Certification: Current license to practice as a Registered Nurse in their home state or...nursing experience with at least 2 years' experience in utilization review or case management .… more
- Humana (Charleston, WV)
- **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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...in nursing (BSN) + Previous experience in discharge planning, utilization management or case … more
- Actalent (Sunrise, FL)
- …Florida license ( RN , LCSW, LMSW, LPHA, or LMHC). + 2+ years in utilization review/ case management ; 1+ year in acute care discharge planning preferred. ... Utilization Management Behavioral Health ClinicianUtilization Management Behavioral Health Clinician We're seeking a dedicated Behavioral Health Clinician to… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …Nurse in the State of Florida. + 3 years minimum experience in discharge planning, utilization management , or case management . + Basic proficiency in ... healthcare needs of the patients using the functions of Utilization Resource Management , Transition of Care, Discharge Planning, and Case Management . +… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + **One year** ** Utilization Review or Case Management experience.** **Licenses ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...Required** + Current license to practice as a Registered Nurse in the State of Utah,… more
- WellSpan Health (Lebanon, PA)
- …per 2 week pay period **General Summary** Performs a variety of duties and applies utilization and case management techniques to determine the most efficient ... patient discharge needs. Provides leadership in the integration of utilization and case management principles...., or Clinical Nursing Specialty. Preferred **Licenses:** + Licensed Registered Nurse Upon Hire Required or +… more
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