- Arnot Health (Bath, NY)
- …areas suitable for nursing research. + Promotes research-based practice. Standard VIII. Resource Utilization The Nurse Manager evaluates and administers the ... Professional Performance Standard I. Quality of Care and Administrative Practice The Nurse Manager systematically evaluates the quality and effectiveness of… more
- Prime Healthcare (Weslaco, TX)
- …Criteria preferred. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/210205/registered- nurse -case- manager utilization ... -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityKnapp Medical Center LocationUS-TX-Weslaco ID2025-210205 CategoryClinical Professional Position TypeFull Time ShiftDays Job TypeNon-Exempt more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered ... Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review, discharge planning and monitors quality assurance for Lahey… more
- Dartmouth Health (White River Junction, VT)
- … – Home Health PRN, Days Why work as a Utilization Review Case Manager at Visiting Nurse and Hospice for Vermont and New Hampshire? * You experience ... one 4-hour flex shift to be discussed with hiring manager . Locations: * Fully remote work in all statesexcept:...CT, MA, MD, NJ, NY, OH, RI, WY. Visiting Nurse and Hospice for VT & NH covers more… more
- CareOregon (Portland, OR)
- …Manager Direct Reports Registered Nurse - Clinical Quality Assurance, Registered Nurse - Utilization Management II Manager Title Director, Quality ... Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Quality Assurance Manager , Clinical Systems Requisition # 25017 Exemption Status Exempt Management Level… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... resource to the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs & NCDs). This position… more
- Actalent (Sunrise, FL)
- Actalent is hiring UM nurses!Job Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization of healthcare ... services. Working under the general supervision of the Director and/or Manager /Supervisor of Medical Management, and in collaboration with an interdisciplinary team,… more
- Elevance Health (Morgantown, WV)
- RN Utilization Management/Review Nurse - InPatient Medicaid (JR155056) **Location:** This position requires you to **reside in the state of West Virginia.** ... Monday through Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review) is responsible for...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… 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: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- University of Utah Health (Salt Lake City, UT)
- …advancement, and overall patient outcomes. **Responsibilities** + Applies approved utilization criteria to monitor appropriateness of admissions with associated ... or third-party payer. + Alerts and discusses with physician/provider and case manager /discharge planner when patient no longer meets medical necessity criteria for… more
- Humana (Louisville, KY)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied and… more
- AmeriHealth Caritas (Philadelphia, PA)
- …Clinical Care Reviewer refers the member to a Special Needs/Pediatric Shift Care Case Manager and works collaboratively with that Case Manager to ensure the ... longer needed or until the member's 21st birthday. ;The nurse will maintain current knowledge and understanding of the...a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization.… more
- Dignity Health (Mesa, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use ... admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is...five (5) years of nursing experience + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or… more
- US Tech Solutions (Columbia, SC)
- …Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates ... education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate… more
- Beth Israel Lahey Health (Plymouth, MA)
- …the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Beth Israel Lahey Health (Plymouth, MA)
- …the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- UNC Health Care (Raleigh, NC)
- …are currently seeking an experienced nurse to join our dynamic team as an RN Utilization Manager . Role is full time, 40 hours per week, on site._ Become part ... care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical ... and verbal communication skills. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure Current RN license as… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing the ... daily operation of the Utilization Management Review Nurse and Specialist staff...decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director… more
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