- ICW Group (Pleasanton, CA)
- …assessment and evaluate needs for treatment in worker's compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical ... regulatory standards. + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and… more
- UPMC (Pittsburgh, PA)
- Are you an experienced nurse looking for the next challenge in your career? Do you have knowledge of care management or care coordination? Check out this fantastic ... new opportunity! UPMC Health Plan is hiring a full-time Telephonic Care Manager to support the Medicare line of business within the Allegheny Care Management Team.… 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 ... have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. + A typical day would be managing a… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- ChenMed (North Miami Beach, FL)
- …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... great people to join our team. The Acute Care Nurse (RN) is responsible for achieving positive patient outcomes...experience required. + A minimum of 1 year of utilization review and/or case management, home health,… more
- Matrix Providers (Fairfield, CA)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... Registered Nurse - Disease Management Location: Fairfield, CA, United...facility treatment team referrals. Facilitates identification, adoption, implementation and utilization of standardized clinical practice guidelines and protocols for… more
- ChenMed (Tampa, FL)
- …Proven working experience in Case Management: + A minimum of 2 years' utilization review and/or case management, home health and/or discharge planning experience ... + Under the direction and supervision of a Registered Nurse (RN) provides in home and telephonic visits to patients at high-risk for hospital admission and… more
- Actalent (Tampa, FL)
- … review experience and/or discharge planning. + At least 2 years of utilization review /management experience. + 1 year of experience within Case Management or ... Title: PAC Nurse Job Description The PAC Nurse position involves telephonic responsibilities focused on...issues to the supervisor for resolution. + Conduct scheduled telephonic touchpoints with facility personnel to review … more
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- …and from the community. Possesses the knowledge related to VHA guidelines, utilization review criteria, current evidence-based standards of care, compliance ... Health System (NF/SG VAHS) is recruiting for a Registered Nurse Care Coordinator to work in the Office of...to achieve desired patient outcomes through day-to-day and/ or telephonic care coordination and management. The RN Care Coordinator… more
- Sharecare (Orem, UT)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is ... To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and objectives of the… more
- Health Advocates Network (Pittsburgh, PA)
- …setting, behavioral health setting, drug and alcohol setting, managed care, quality management/ utilization review or other related clinical experience; or An ... R&E Nurse - Med Care Services- Intermediate **Pay Rate:** $25...(MA), health care services, human services, long term care, utilization review , or knowledge of home care… more
- CVS Health (Indianapolis, IN)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- ERP International (Luke AFB, AZ)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... **Overview** ERP International is seeking full time **Registered Nurse - Case Management** in support of the56th Medical Group at Luke AFB, AZ… more
- Baystate Health (Springfield, MA)
- **RN, ACO Nurse Care Manager, High Street Community Health Center** The **ACO Nurse Care Manager i** s responsible for the management of care for a defined group ... face visits, home visits if necessary, as well as telephonic interactions. In addition, they will assist with advance...room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that… more
- Nuvance Health (Poughkeepsie, NY)
- …or BSN preferred. Must have current RN license. Preferred experience in Utilization Review /Management.Company: Vassar Brothers Medical Center Org Unit: 1190 ... affiliates, Position Summary: Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support the… 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 ... to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high risk pregnancy or… more
- Humana (Richmond, VA)
- …Humana Healthy Horizons in Virginia is looking for a Quality Compliance Nurse Professional 2 (Maternal-Child Health/EPSDT) who will collaborate with all departments ... family planning services and preventive health strategies. The Quality Compliance Nurse Professional 2 (Maternal-Child Health/EPSDT) works to ensure that children… more
- CVS Health (Charleston, WV)
- …and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes. **What you will ... do** + Responsible for telephonic and/or face to faceassessment, planning, implementing and coordinating care managementactivities with members to ensure that… 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
- CVS Health (Doral, FL)
- …and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes. The schedule for ... or Thursday as the flex day. **Position Responsibilities:** + Responsible for telephonic and face to face assessment, planning, implementing and coordinating care… more
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