- 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 for ... reviews). - Hire, train and mentor UM staff, including nurse reviewers and support personnel. - Act as liaison...Skills & Abilities (must have): - Expertise in managing utilization review processes including prior authorization, concurrent… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is… more
- 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
- Stony Brook University (Stony Brook, NY)
- Registered Nurse 1 (T&RC) - Blood Donor Full-Time Day Shift **Position Summary** At Stony Brook Medicine, our Registered Nurses are critical members of the ... while adhering to a medical regimen. **Duties of a Registered Nurse in the Blood Donor Department...Donor and Therapeutic Apheresis as assigned.. + Perform blood utilization quality assurance, donor related work as assigned. +… more
- Providence Little Company of Mary Medical Center - San Pedro (San Pedro, CA)
- …Offering Nursing Profession RN Specialty Case Manager Job ID 33531206 Job Title Registered Nurse - Case Manager @ Providence Little Company of Mary Medical ... Date 12/08/2025 Duration 13 Week(s) Job Description Job Title: Case Manager Profession: Registered Nurse Specialty: Case Management Duration: 13 weeks Shift: Day… more
- Luke Staffing (Glendale, CO)
- …- Friday, 7:30 AM - 5:30 PM (excluding federal holidays) **POSITION OVERVIEW:** The Registered Nurse ( RN ) will provide on-site professional nursing services ... ** REGISTERED NURSE ** **SITE OF SERVICE:** Department...of Veterans Affairs' Eastern Colorado Healthcare System (ECHCS). The RN will serve in the Office of Community Care… more
- ERP International (San Diego, CA)
- **Overview** ERP International is seeking a full-time ** Registered Nurse ( RN ) Health Educator** supporting **Naval Medical Center San Diego, CA ... of other individuals performing similar services. ? Participate in peer review and performance improvement activities. ? Practice aseptic techniques as necessary.… more
- Katmai (Fort Carson, CO)
- …RESPONSIBILITIES** None. **Job Requirements:** **MINIMUM QUALIFICATIONS** + Associates Degree of Nursing. Registered nurse shall be a graduate from a college or ... those required of any military or government civil service nurse of similar experience and in similar duty assignments....+ Shall possess a current, active, full and unrestricted Registered Nurses ( RN ) licensed in Colorado or… more
- Stanford Health Care (Palo Alto, CA)
- …job.** **A Brief Overview** The Oncology Research Nursing Professional (ORNP) -is a Registered Nurse ( RN ) who works collaboratively with Clinical Research ... site visits and study close-outs; and collaborates on the review of documentation during protocol audits. + Develops protocol...in a research related degree **Licenses and Certifications** + CA- RN ( Registered Nurse ) . +… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …or four (4) years' work experience **(Required)** + Current State Licensure as a registered nurse where licensing is required by State law **(Required)** + Three ... our Healthsource blog: https://healthsource.premera.com/ . The **Care Coordinator - Inpatient RN ** performs reviews of admissions and concurrent stay requests for… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …or four (4) years' work experience (REQUIRED) + Current State Licensure as a registered nurse (REQUIRED) + Three (3) years of clinical experience (REQUIRED) + ... . The **Care Coordinator** - **Clinical Appeals** performs prospective review (benefit advisory/ prior authorization) admission, concurrent, and retrospective… more
- Alameda Health System (San Leandro, CA)
- …preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or ... SLH Case Manager RN + San Leandro, CA + San Leandro...Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.… more
- Alameda Health System (San Leandro, CA)
- …necessarily performed by each individual in the classification. + Coordinates all utilization review functions, including response to payor requests for ... experience in Case Management in an acute setting or utilization review at a medical group or...or health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California,… 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
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- … RN Appeals Coordinator.** This role collaborates with clinical review staff, medical directors/physician reviewers, network physicians, and network facilities to ... Friday; 8:00 AM -5:00 PM CST (Flexible) **Responsibilities** A. Performs necessary review to ensure compliance with HHSC and other regulatory entities + Collaborate:… more
- Stanford Health Care (Palo Alto, CA)
- …affect the processes and outcomes of patient health care **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient… more
- Commonwealth Care Alliance (Springfield, MA)
- …to influence the outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment and closing gaps in care through connecting patients ... services. The CHW will play an integral role supporting patients with frequent utilization of Emergency Departments and acute admissions with the goal of identifying… more
- Commonwealth Care Alliance (Springfield, MA)
- …influence the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for behavioral health needs, and closing quality ... Timely Psychiatric post hospital discharge with focus on hospitalization and utilization reduction + Facilitating and/or delivering preventative care and behavioral… more
- Commonwealth Care Alliance (Boston, MA)
- …discussion, and development of key performance indicator monitoring, KPI chart review and quality review processes, productivity standards. - Demonstrates ... providing team feedback based on data, key performance, and quality chart review processes. - Work cross-functionally within the organization to develop and document… more
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