- Commonwealth Care Alliance (Springfield, MA)
- …member needs are consistently met + Manage panel-wide and member-specific utilization trends. + Liaise with CCA and community-based PCPs/specialists + Collaborate ... planning. + MA / MI only: Reviews approved authorizations to assess appropriate utilization , based on members' needs + Actively participate in the evaluation of own… more
- University of Washington (Seattle, WA)
- …artistic pursuits, and natural beauty. Requirements: Current license to practice as a Registered Nurse in the State of Washington. Minimum of three years ... benefits for this position, click here (https://hr.uw.edu/benefits/wp-content/uploads/sites/3/2018/02/benefits-summary-classified-staff-greater-than-half-time-20220908\_a11y.pdf) . RN2, Utilization Management Specialist. This is a hybrid … more
- Beth Israel Lahey Health (Wakefield, MA)
- …care system considered in lieu of degree + Active, unrestricted Massachusetts Registered Nurse License required. Certification in Case Management (CCM) ... in healthy behavior. Working with the healthcare team, the Care Manager, RN monitors appropriate utilization of healthcare resources, promotes quality and… more
- Bassett Healthcare (Cooperstown, NY)
- …needs. The RN contributes to the support of patients through interdisciplinary teamwork. Registered Nurse I: The RN I status is only appropriate for ... after hire. Salary Range: $36.76 - $55.13 per hour Registered Nurse II: The RN ...as measured by periodic random preceptor and supervisory chart review as per probationary appraisal schedule ( RN … more
- Kepro (Indianapolis, IN)
- …other information applicable to the position assignment. Required Qualifications/Experience: + Active Registered Nurse ( RN ) or Licensed Practical Nurse ... partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/ RN to join our growing team.… more
- HCA Healthcare (Round Rock, TX)
- …Science in Nursing (BSN) - preferred** **Licenses and Certifications** + **Current State of Texas Registered Nurse ( RN ) license or Compact Registered ** + ... management/administrative team to ensure staff productivity and appropriate resource utilization to achieve high quality patient care while meeting...encourage you to apply for our Registered Nurse Supervisor House PRN opening. We review … more
- WellSpan Health (York, PA)
- Registered Nurse - Surgical ICU -...Hospital, York, PA Schedule: Full Time Sign-On Bonus Eligible Remote/ Hybrid Regular Apply Now See More Events Full time/ ... Degree Nursing (BSN) Preferred Work Experience: + No experience. Required Licenses: + Licensed Registered Nurse Upon Hire Required or + Registered Nurse… more
- HCA Healthcare (Round Rock, TX)
- …We want your knowledge and expertise! **Job Summary and Qualifications** As a Registered Nurse Case Manager you will be responsible for promoting ... supporting a balance of optimal care and appropriate resource utilization . + You will provide case management services for...preferred Licenses and Certifications + Currently licensed as a Registered Nurse in the state(s) of practice… more
- Universal Health Services (Temecula, CA)
- …The Southwest Healthcare Regional office in Temecula, CA is seeking Two (2) Full-Time RN Central Utilization Review Nurses who will be responsible for ... correct payer source for hospitalization and communication. + Ensures compliance of utilization review practices as required by payers, external regulatory… more
- State of Indiana (Indianapolis, IN)
- Utilization Review Coordinator Date Posted: May 31,...accredited college or university. * Current licensure as a Registered Nurse ( RN ) in the State ... to the treatment team. * Development of the annual utilization review plan. * Serve as the...practice nursing in the State of Indiana as a Registered Nurse . + Must hold and maintain… more
- Centene Corporation (OK)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with...holidays, and a flexible approach to work with remote, hybrid , field or office work schedules. Actual pay will… more
- Kepro (Chicago, IL)
- …Supervising and managing the day-to-day activities of the assigned case management and utilization review teams. + Mentoring, coaching, and training team members ... public sector. Acentra seeks a Clinical Operations Manager - RN ( Hybrid within Illinois) to join our...Supervises, mentors, coaches, trains, and develops the: o Case review and utilization review teams… more
- Centene Corporation (Phoenix, AZ)
- …and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State ... abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with...holidays, and a flexible approach to work with remote, hybrid , field or office work schedules. Actual pay will… more
- Centene Corporation (Salem, OR)
- …related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review … more
- Humana (Richmond, VA)
- …phone calls **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) compact licensure with no disciplinary action ... Utilization Management Nurse 2/Home Health Utilization Management: + Review cases using clinical...is a plus **Work-At-Home Requirements** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided… more
- Kepro (Summersville, WV)
- …community. + Ensure day-to-day processes are conducted in accordance with the Utilization Review Accreditation Commission (URAC) and other regulatory standards. ... health solutions in the public sector. Acentra seeks an RN Complex Case Manager in West Virginia to join...NOTE: ** This is a full-time, direct hire, exempt, Hybrid opportunity with Benefits. ** The selected candidate is… more
- Centers Plan for Healthy Living (Margate, FL)
- RN Care Manager ( Hybrid ) 5297 W...other providers involved in the member's care. + Initiates utilization review for preauthorization and post service ... setting + Experience working within a managed care environment We offer: + Hybrid schedule (for employees who qualify) Care Solutions is committed to leveraging the… more
- Conviva (Austin, TX)
- …to others. Preferred Locations: Daytona, FL, Louisville, KY, San Antonio, TX The Utilization Management Nurse utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse work assignments are varied and frequently… more
- CareFirst (Baltimore, MD)
- …in addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact ... who is willing and able to work in a hybrid model. The incumbent will be expected to work...and Abilities (KSAs)** + Knowledge of NCQA requirements of utilization review , Case Management standards and guidelines,… more
- Corewell Health (Wayne, MI)
- …management, utilization review , home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon Hire required ... patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2.… more