- Dartmouth Health (Lebanon, NH)
- Overview The Manager of Utilization Management is responsible for day to day operations of the utilization review program at multiple Dartmouth Health ... leadership, communication and computer skills desired. Required Licensure/Certifications - Licensed Registered Nurse with NH eligibility - BLS certification… more
- UCLA Health (Los Angeles, CA)
- …the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management ... a self-motivated, detail-oriented, service-driven leader with: + Current unrestricted RN licensure in CA required + Bachelors of Science,...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- Veterans Affairs, Veterans Health Administration (St. Louis, MO)
- …(VASTLHCS), St. Louis, Missouri. The Registered Nurse Case Manager ( Utilization Management ) demonstrates leadership, experience, and creative ... approaches in providing complex patient management in delivering and improving holistic care through collaborative...Nurse Total Rewards The primary purpose of this Registered Nurse Case Manager (RNCM)… more
- Healthfirst (NY)
- **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes: + Pre-certification performing risk-identification, ... Negotiates rates with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community resources to… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …years of progressively responsible and directly related work experience License/Certification: CA Registered Nurse ( RN ) Knowledge, Skills, & Abilities These ... include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness… more
- Cedars-Sinai (Los Angeles, CA)
- …thereafter as a condition of continued employment. **Req ID** : 4300 **Working Title** : Utilization Management Case Manager - 8 Hour Days Per Diem ... from an accredited nursing program required. Bachelors Degree in Nurse preferred. California RN License required. **Experience:**...**Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical… more
- Prime Healthcare (Montclair, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/175009/case- manager -%28rn%29 utilization - management ... an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute… more
- Prime Healthcare (North Las Vegas, NV)
- …computer skills. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/174491/case- manager -%28rn%29 utilization - management ... an accredited school of nursing and a current state Registered Nurse license2. Grandfathered prior to April...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute… more
- Molina Healthcare (NV)
- …not a compact state at this time.** **Prior experience with managed care (Medicaid, Medicare) Utilization Management processes and 3 + years in management / ... performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.),… more
- UNC Health Care (Raleigh, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection...date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North… more
- Trinity Health (Silver Spring, MD)
- …MD **Description:** + Full-Time 8am - 4:30pm + Reporting to the Director of Care Management + The RN Manager is responsible and accountable for the ... will need:** + State of Maryland license as a Registered Nurse + BSN required; MSN Degree...required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At… more
- AdventHealth (Altamonte Springs, FL)
- … will oversee ED, Inpatient, and Specialist utilization , and manage care management outcomes. The Senior Manager of Utilization will provide support, ... and guidance to the RN on care management duties/assignments. The Senior Manager of ...degree in nursing with 4 years of experience. . Registered Nurse with an active and unrestricted… more
- BronxCare Health System (Bronx, NY)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients,… more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager ** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 Your career starts now. We ... Officer for the Ohio Market, this position is representing Utilization Management (UM) in state interactions/audits, validation...RN license in OH. + 3+ years of utilization /case management experience in relevant scope preferred,… more
- ERP International (Corpus Christi, TX)
- **Overview** ERP International is seeking a ** Registered Nurse ( RN )** ** Utilization Manager ** for a full-time position in support of the **Naval ... of this position, it must be directly related to referral/ utilization management . License:** Active, unrestricted RN license Board Certification:**… 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 ... **Organization:** Bay Administration **Position Overview:** Responsible for Utilization Management and accurate bed placement...of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon… more
- RWJBarnabas Health (Livingston, NJ)
- Case Manager Registered Nurse ( RN ), Case...setting + Minimum of one year experience in Case Management / Utilization Management or Home Care ... Hills Road, Livingston, NJ 07039 Job Summary: The Case Manager Registered Nurse develops safe...population across the continuum of illness. Assumes responsibility for utilization management and monitoring process. Conducts admission… more
- HCA Healthcare (Richmond, VA)
- …at Chippenham Hospital have the opportunity to make a real impact. As a Registered Nurse RN Case Manager you can be a part of change. **Benefits** ... by location._ We are seeking a Registered Nurse RN Case Manager for...experience in a hospital setting preferred.** + **Previous case management or utilization review experience preferred.** CJW… more
- LA Care Health Plan (Los Angeles, CA)
- …Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse ( RN ); current and unrestrited California License. ... Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range Disclaimer: The… more
- Humana (Louisville, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more