- Aveanna Healthcare (Birmingham, AL)
- $7500 Sign-On Bonus Position Overview: The Hospice Registered Nurse is responsible for pain management , symptom control in the delivery of care to hospice ... of care and patient needs. Participates in quality improvement, utilization review , and infection control activities as...Time, and Paid Holidays Qualifications: Current license as a Registered Nurse in the State of Alabama… more
- Quadrant Inc (Springfield, VA)
- …weight loss, and dehydration Participating in Wound Rounds, Operations Meetings, Utilization Review , and Performance Improvement/Risk Management /Safety ... Registered Nurse Assistant Director Springfield, VA Pay From: $55 per hour MUST: The Registered Nurse - Assistant Director must have experience with: … more
- Providence Little Company of Mary Medical Center - San Pedro (San Pedro, CA)
- …Date 12/08/2025 Duration 13 Week(s) Job Description Job Title: Case Manager Profession: Registered Nurse Specialty: Case Management Duration: 13 weeks Shift: ... - 16:30 Experience: Minimum of 2 years in Case Management License: Registered Nurse License...discharge planning and utilize interqual criteria - Experience in utilization review and concurrent reviews Description: This… more
- Providence Little Company of Mary Medical Center San Pedro-… (San Pedro, CA)
- … License Certifications: BLS - AHA Must-Have: Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager ... ensure timely, efficient, and effective discharge planning and transitions. Supports utilization management and ensures compliance with payer guidelines.… more
- Skaggs Community Hospital Association (Branson, MO)
- …and utilization of Aseptic Technique. Licensure/Certification/Registration: ▪ Required:Missouri State Registered Nurse AND Certified as a Registered ... and utilization of Aseptic Technique. ◦ Licensure/Certification/Registration ▪ Required:Missouri State Registered Nurse AND Certified as a Registered … more
- University of New Mexico - Hospitals (Albuquerque, NM)
- …patient responses to interventions in collaboration with quality assurance and utilization review , maintaining interdependent follow-up as necessary * VARIANCES ... education, and other business and organizational considerations. Department: OP Care Management Svcs FTE: 1.00 Full Time Shift: Days Position Summary: Supervise… more
- Texas Health Resources (Arlington, TX)
- Director Utilization Management -Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes...3 years previous leadership experience required Licenses and Certifications RN - Registered Nurse Current… 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 ... and Barnstable counties. Our Nutrition Services Team consists of registered and licensed dietitians who provide expert nutritional interventions...and Serve Your Community!** **In your role as a Utilization Review & Denials Management … more
- US Tech Solutions (Chicago, IL)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in...+ Do you have experience with Utilization Review ? + Do you have an Active Registered… more
- US Tech Solutions (May, OK)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... . 1+ years of inpatient hospital experience . Registered Nurse in state of residence ....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST HAVE… 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 ... reports to the Director of Utilization Management * Oversees clinical decision review for...reviews). * Hire, train and mentor UM staff, including nurse reviewers and support personnel. * Act as liaison… more
- Elevance Health (Costa Mesa, CA)
- RN Utilization Management Nurse (NICU...- 6pm PST. Rotating Weekends and holidays. The **Medical Management Nurse ** is responsible for review ... Director on particularly peculiar or complex cases as the nurse deems appropriate. + May make recommendations on alternate...clinical experience in NICU / Peds strongly preferred. + Utilization management / review within managed care… more
- Humana (Lincoln, NE)
- **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...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Ventura County (Ventura, CA)
- Senior Registered Nurse - Hospital Management Utilization Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5061650) Apply Senior ... Registered Nurse - Hospital Management Utilization ...general and specialized principles, practices, techniques and methods of utilization review / management , discharge planning or… more
- CaroMont Health (Gastonia, NC)
- …license to practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management , Quality and/or Case Management ... to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments,… more
- Molina Healthcare (San Francisco, CA)
- …team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management activities ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating ... *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management...skill set *_QUALIFICATIONS:_* /*Minimum Qualifications:*/ * 1 year of recent* utilization review , utilization management… more
- Community Health Systems (Franklin, TN)
- …discharge planning, and payer requirements. + Documents all utilization review activities in the hospital's case management software, including clinical ... Nursing preferred + 2-4 years of clinical experience in utilization review , case management , or...regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse -… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …the appropriate utilization of resources, coordination of payer communication, and utilization review and management . Responsible for carrying out duties ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager* to join ourTransitional...in confidentiality, integrity, creativity, and initiative */License/Certifications:/* * Current Registered Nurse licensure upon hire * National… more
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