- McLaren Health Care (Pontiac, MI)
- …12. Performs other duties as assigned. #LI-KH1 _Required_ + State licensure as a Registered Nurse ( RN ) + Bachelor's degree in nursing from accredited ... needs in EMR for continued communication with ICM UM RN and Care Management staff 7. Assesses...years of acute hospital care experience + Two years utilization and/or case management experience… more
- Elevance Health (Buffalo, NY)
- RN Utilization Management - Case Management (Medicaid Long Term Care) JR155671 **Location** : New York or New Jersey. **Virtual:** This role enables ... face-to-face onboarding and skill development as needed. The **Medical Management Nurse ** is responsible for review of...and Experiences:** + A combination of utilization review/ utilization management and Case … more
- WellSpan Health (York, PA)
- …WellSpan's geographic footprint._** **General Summary** Performs a variety of reviews and applies utilization and case management techniques to determine the ... + 3 years Relevant experience. Required + Experience in utilization management , case management...administration or management . Preferred **Licenses:** + Licensed Registered Nurse Upon Hire Required or +… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time ... **Location** : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management ,...resource for navigating post-acute care services. **Minimum Qualifications:** + RN licensed by the State of Maryland or Compact… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager, Utilization Management /ReviewDepartment:Patient Services-Patient Care ... a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current...license as a Registered Nurse ( RN ) + A certification as a Certified Case… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day ... 15, 2025 **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN ...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN ...an acute hospital setting. At least 2 years of Utilization Management / Case Management ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse , Revenue Integrity & Utilization Management Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant ... by Forbes as a Best Employer. Position Summary: The RN Utilization Management I will...word and excel. Licensure Requirements: Current licensure as a Registered Nurse ( RN ) as issued… more
- Houston Methodist (The Woodlands, TX)
- …two years in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure - ... Review Nurse (URN) position is a licensed registered nurse ( RN ) who comprehensively...state, local, and federal programs + Progressive knowledge of utilization management , case management… more
- Humana (Charleston, WV)
- **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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...in nursing (BSN) + Previous experience in discharge planning, utilization management or case … more
- Humana (Fort Myers, FL)
- **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 ... of medical services, discharges and/or benefit administration determinations. The Utilization Management Nurse 2 work...a related field + Previous experience in discharge planning, utilization management or case … more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …Nurse in the State of Florida. + 3 years minimum experience in discharge planning, utilization management , or case management . + Basic proficiency in ... healthcare needs of the patients using the functions of Utilization Resource Management , Transition of Care, Discharge Planning, and Case Management . +… more
- WellSpan Health (Lebanon, PA)
- …per 2 week pay period **General Summary** Performs a variety of duties and applies utilization and case management techniques to determine the most efficient ... patient discharge needs. Provides leadership in the integration of utilization and case management principles...., or Clinical Nursing Specialty. Preferred **Licenses:** + Licensed Registered Nurse Upon Hire Required or +… more
- Humana (Tallahassee, FL)
- **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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Active Registered Nurse ( RN ) license in,… more
- HonorHealth (AZ)
- …a Case Management Department - PreferredLicenses and Certifications Other Accredited Case Manager - Preferred Registered RN Or Licensed Social Worker ... departments. Oversees clinical operations for managed care plan contracts including utilization management , case management , and social services.… more
- Hackensack Meridian Health (Hackensack, NJ)
- …and regulatory/payer requirements. The role integrates and coordinates utilization management , care coordination, and discharge planning functions. RN ... with Nursing. **Education, Knowledge, Skills and Abilities Required:** + Case Manager, Registered Nurse Graduate...PC skills. + Current working knowledge of discharge planning, utilization management , case management… more
- RWJBarnabas Health (Newark, NJ)
- …settings. Additionally, candidates must have at least 3 years of recent experience in Case Management , Utilization Review, or Discharge Planning, and a ... federal guidelines and is accountable for case management outcomes as outlined in the Utilization ...+ Current and valid license to practice as a Registered Nurse or Social Worker in the… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management RN , to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned ... + One (1) year previous experience in Managed Care Utilization Management , Medical Management , Case Management . **Preferred:** + Two (2) years'… more
- Providence (Mission Hills, CA)
- …California Registered Nurse License upon hire + 3 years of experience in utilization management and/or case management . + 3 years of clinical ... **Description** Responsible for providing utilization review and coordination of care throughout the...Degree in Nursing or related field. + Certification in Case Management (CCM) upon hire **Why Join… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse ( RN ) who comprehensively plans for case management of a ... management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -...and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management… more