- UNC Health Care (Smithfield, NC)
- …care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management ... and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and...date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …in confidentiality, integrity, creativity, and initiative */License/Certifications:/* * Current Registered Nurse licensure upon hire * National certification ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional...to 5) years of professional leadership experience (ie, charge nurse , team leader, preceptor, committee chair, etc.) * Five… more
- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Aug 22, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career ... care and their communities. Role Overview: The role of Utilization Management Manager oversees the integration of...and clinical criteria evaluations.They will possess a current unrestricted RN license from the State of Indiana; a minimum… more
- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… 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 We ... Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical… more
- CareFirst (Baltimore, MD)
- …+ Proficient in Microsoft Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\ RN - Registered Nurse - State Licensure and/or ... **Resp & Qualifications** **PURPOSE:** Manages the utilization of referral services. Enhances quality of care...FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. +… more
- Children's Mercy Kansas City (Kansas City, MO)
- …experience + Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire ... training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including...+ One of the following: Licensed RN - Kansas, Registered Nurse … more
- CVS Health (Oklahoma City, OK)
- …do it all with heart, each and every day. **Position Summary** The Manager , UM Clinical Services, conducts oversight and management of clinical team processes ... outcomes. **Required Qualifications** + Must reside in Oklahoma + Oklahoma-licensed RN or Mental Health Professional- Licensed Professional Counselor (LPC), Licensed… more
- Virtua Health (Pennsauken, NJ)
- …Nursing.Training/Certifications/Licensure:Licensure from the State of New Jersey as a Registered Nurse .Case Management Certification (requirement within one year ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- Sutter Health (Auburn, CA)
- …patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely ... + Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** +… more
- Sutter Health (Burlingame, CA)
- …patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely ... : **EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire CCM certification… more
- UNC Health Care (Smithfield, NC)
- …date (EDD). Complete follow-up from CAPP as appropriate. As necessary meet with the Utilization Manager (UM) and SW after the meeting to discuss updates and ... issues with complex patients and identify trends. Formulate potential solutions with Utilization Manager and Social Worker and continuously monitor cases/follow… more
- Mayo Clinic (Rochester, MN)
- …rounds and collaborates to potentially impact length of stay. The Registered Nurse ( RN ) Case Manager works within an interdisciplinary team to ... workers, physicians and multi-disciplinary teams. Major Functions of the RN Case Manager include: Utilization ...Graduate of a Nursing program. All entry-level associate degree registered nurses with a RN start date… more
- Centene Corporation (Phoenix, AZ)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... and/or Tucson offices.** **Position Purpose:** Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care to members. Oversees and… more
- UPMC (Pittsburgh, PA)
- Are you a registered nurse with a background in utilization management? Are you interested in the opportunity to work from home? UPMC Health Plan is looking ... for you! We are hiring a full-time Utilization Management Care Manager to support...Case management certification or approved clinical certification preferred + Registered Nurse ( RN ) *Current licensure… more
- CenterWell (Tampa, FL)
- …for managing populations and coordinating care to reduce acute and post-acute care utilization . The Manager role is hybrid with travel requirements to preferred ... caring community and help us put health first** The Manager Care/Case Management in **Tampa area (** **_this is...action plans that will reduce acute and post-acute care utilization . + Solicits/shares feedback with market leaders on team-based… more
- Monroe County, NY (Rochester, NY)
- Full Jobs List Full Exams List Registered Nurse ( RN ) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse ( RN ) ... to, and works under the general supervision of a Nurse Manager , or other higher-level staff member....Qualifications Possession of a New York State License as a Registered Nurse . Download/View Full Announcement Apply… more
- Avera (Pierre, SD)
- …cause undue hardship to the employer. **Required Education, License/Certification, or Work Experience:** + Registered Nurse ( RN ) - Board of Nursing An active ... levels of care, to promote the best possible patient outcome. The case manager facilitates efficient utilization of resources and identifies patient care needs… more
- University of Miami (Miami, FL)
- …of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent conducts ... chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare team for optimal and efficient… more
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