- Centene Corporation (Atlanta, GA)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. **(Must reside in Georgia).** + Monitors and tracks… more
- Actalent (Sunrise, FL)
- Job Title: Utilization Management NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization ... + Clinical review + Utilization review + Utilization management +... Additional Skills & Qualifications + Current unrestricted Florida RN or LPN License + Minimum of two years… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... collaboration with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - ... The System Utilization Management [SUM] Utilization Review RN is responsible...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… 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
- Crouse Hospital (Syracuse, NY)
- …and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse ( RN ) to track and manage data ... (typically requires 6 weekends a year). Utilization Management Registered Nurse ( RN...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours a week. + **Hospital:** Ascension Saint Thomas + **Location:** ... TN market. We're looking for an experienced Director of Utilization Management to join our team! In...all clients. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Tennessee Board… more
- Hackensack Meridian Health (North Bergen, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- AdventHealth (Altamonte Springs, FL)
- …role you will contribute:** The role of the Utilization Management (UM) Registered Nurse ( RN ) is to use clinical expertise by analyzing patient ... including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable...of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,… 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 ... in a direct patient care clinical setting. Must have utilization management , utilization review...full, active, and unrestricted license to practice as a Registered Nurse as required in the TO… more
- CVS Health (Austin, TX)
- …operation. Work schedules may include weekends and holidays and evening rotations._ As a Utilization Management Nurse Consultant you will be responsible for ... **Required Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current...work Monday through Friday 8:00am to 5pm CST + Utilization management is a 24/7 operation. Work… more
- Stanford Health Care (Palo Alto, CA)
- …3+ years of experience in case management - 3+ years of experience in utilization review Why work at Stanford Medicine | Stanford Health Care (SHC)? - ... + Knowledge of principles and best practices of case management , utilization review , social work,...to address them. **Licenses and Certifications** + Nursing / RN - Registered Nurse -… more
- Intermountain Health (Murray, UT)
- …FEHB, Marketplace Qualified Health Plans, fully funded and self-funded Commercial plans. Utilization Review nurses at Select Health proactively oversee inpatient ... regarding authorizations, approved treatment plan and length of stay. **Skills** + Utilization Management + Clinical Expertise + Independent and autonomous +… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time ... Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management , you will be the key...care and address clinical documentation needs for accurate case review and status determination. + Oversee the continuity of… more
- Penn State Health (Hershey, PA)
- …(MAILTO://###@pennstatehealth.psu.edu) Penn State Health is seeking a dedicated ** Utilization Management Specialist** to join our team ... inpatient bedside nursing experience** , along with experience in ** Utilization Management ** -either from the provider side...is required. + Currently licensed to practice as a Registered Nurse by the state of employment… more
- HCA Healthcare (Richmond, VA)
- …Licensed Clinical Social Worker (LCSW), or Licensed Professional Counselor (LPC), or ( RN ) Registered Nurse CJW Medical Center (http://www.cjwmedical.com/) is ... that invests in you as a(an) Case Manager Behavioral Utilization Management ? At Chippenham Hospital, you come...in evaluating medical necessity. + Performs admission and concurrent review for all payors and maintains legible documentation as… more
- CVS Health (Harrisburg, PA)
- …work Monday through Friday 8:30-5pm EST. No weekends or holidays. - 1+ years of utilization review / utilization management required - 3+ years of ... in the state of residence (LMSW, LCSW, LISW, LPC, or comparable) or Registered Nurse licensure with psychiatric specialty, certification, or experience in state… more
- CVS Health (Harrisburg, PA)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... of residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical...and/or Critical care setting + Managed Care experience + Utilization review experience + Experience working with… more
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