- Cedars-Sinai (Los Angeles, CA)
- …thereafter as a condition of continued employment. **Req ID** : 4300 **Working Title** : Utilization Management Case Manager - 8 Hour Days Per Diem ... from an accredited nursing program required. Bachelors Degree in Nurse preferred. California RN License required. **Experience:**...required. **Experience:** + Minimum of 2 years experience in Case Management preferred + Minimum of 3… more
- Stanford Health Care (Palo Alto, CA)
- …Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN ) will be responsible for ensuring the efficient ... of transitions of care guidelines and utilization management principles. + Experience in case ...systems and other healthcare software. **Licenses and Certifications** + Nursing/ RN - Registered Nurse -… more
- Veterans Affairs, Veterans Health Administration (St. Louis, MO)
- …System (VASTLHCS), St. Louis, Missouri. The Registered Nurse Case Manager ( Utilization Management ) demonstrates leadership, experience, and creative ... approaches in providing complex patient management in delivering and improving holistic care through collaborative...Nurse Total Rewards The primary purpose of this Registered Nurse Case Manager (RNCM)… more
- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- …used while maintaining quality of care. Responsibilities The Registered Nurse ( RN ) - Utilization Management (UM) is responsible for reviewing all ... VA Medical Center has a full-time Registered Nurse - Utilization Management position...inpatient admissions, conducting continued-stay reviews, utilization case management , focused studies… more
- BronxCare Health System (Bronx, NY)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients,… more
- AmeriHealth Caritas (Dublin, OH)
- …+ Current and unrestricted RN license in OH. + 3+ years of utilization / case management experience in relevant scope preferred, one year required. + ... ** Utilization Management Plan Oversight Manager** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 Your career starts now. We are… more
- UNC Health Care (Raleigh, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... medical discharge planning issues, continuing care needs by initiating appropriate case management referrals. Initiates appropriate social work referrals. 3.… more
- McLaren Health Care (Detroit, MI)
- …and implementing process improvement projects as needed. _Required:_ + State licensure as a registered nurse ( RN ) + Bachelor's degree in nursing from ... experience with an acute care hospital** _Preferred:_ + Experience in utilization management / case management , critical care, clinical documentation, or… more
- RWJBarnabas Health (Livingston, NJ)
- Case Manager Registered Nurse ( RN ), ...hospital setting + Minimum of one year experience in Case Management / Utilization Management ... Short Hills Road, Livingston, NJ 07039 Job Summary: The Case Manager Registered Nurse develops...on other classifications of patients as designated by the Utilization / Case Management Review Plan. Coordinates… more
- Sharp HealthCare (San Diego, CA)
- …Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... Degree in a health related field. + 3 Years Utilization Management or case ...clinical experience as defined by the CBA. + California Registered Nurse ( RN ) - CA… more
- R1 RCM (Pittsburgh, PA)
- …role, you must have experience in a clinical inpatient environment and hospital-based utilization or case management experience. Proficiency in basic ... testing, training, and other opportunities that promote growth. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… 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
- The Cigna Group (Bloomfield, CT)
- …**Job Requirements include, but not limited to:** + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C + ... Medicare appeals and related issues, implications and decisions. The Case Management Analyst reports to the Supervisor/Manager...+ Education: Licensed Practical Nurse (LPN) or Registered Nurse ( RN ) + 3-5… 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
- Molina Healthcare (NV)
- …one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), case ... identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed...years in one or more of the following areas: utilization management , case management… more
- Fairview Health Services (St. Paul, MN)
- …role (grandfather status) + Current RN licensure in MN + 3-5 years utilization review or case management experience in hospital, clinic, insurance ... **Overview** M Health Fairview has an immediate opening for a Utilization Management Specialist RN . This position provides comprehensive assessment,… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist...oversight, and/or CNA experience. At least 2 years of Utilization Management / Case Management ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and… more
- WellSpan Health (York, PA)
- …Part Time: 20 hours/week General Summary Performs a variety of reviews and applies utilization and case management techniques to determine the most efficient ... care while controlling cost. + Identifies conditions that require case management across the member's episode of...+ Licensed Psychologist Upon Hire Required or + Licensed Registered Nurse with Psychiatric Certification Upon Hire… 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 + ... 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
- WellSpan Health (York, PA)
- Registered Nurse - Case Manager...General Summary Performs a variety of duties and applies utilization and case management techniques to ... 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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