- Sedgwick Government Solutions (Charleston, SC)
- Job Details Utilization Review Case Manager RN ( Remote ) 2025-1434 Charleston, SC, USA Medical Services Full Time Description ** Utilization Review ... and licenses necessary to help support members _?_ The Utilization Review Case Manager RN ...strongly preferred + Unrestricted Current US State or Territory Registered Nurse License + Must hold a… more
- Trinity Health (Columbus, OH)
- …information technology, financial analysis, audit, provider relations and more. **Position Purpose** RN Utilization Review MCHP is responsible for the ... Sr. Director of Medical Management. + Coordinates with the utilization review , case management, discharge planning staff...Licensure / Certification: Current license to practice as a Registered Nurse in their home state or… more
- Dartmouth Health (Lebanon, NH)
- …communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote :Fully Remote * Area ... Overview Utilization Management 30 hours per week Works with physicians and multidisciplinary team members to develop a plan of care for assigned patients. Ensures… more
- AmeriHealth Caritas (Washington, DC)
- …Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred. + A Registered Nurse ( RN ) license in the District of Columbia in ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- BAYADA Home Health Care (Orlando, FL)
- …with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote , Home Health Coding, Coder, ... immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work...Manager with OASIS and Coding certification to work remotely. RN , PT, OT, and SLP's with certifications will be… more
- Ochsner Health (New Orleans, LA)
- …case management or utilization review . **Certifications** Required - Current registered nurse license in state of practice. Basic Life Support (BLS) from ... and implement discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- Community Health Network (Indianapolis, IN)
- Registered Nurse ( RN ) Case Manager - North Job Ref 2502503 Category Nursing Job Family Case Manager Department Case Management Schedule Full-time Facility ... full-time RN Case Manager position available. The Registered Nurse Case Manager is responsible for...effectiveness through the integrating and functions of case management, utilization review and management and discharge planning.… 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
- Banner Health (Gilbert, AZ)
- …the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in ... be the opportunity you've been waiting for. As an RN Case Manager, you will contribute your expertise and...electronic surveillance partnership in caring for the patient, where remote nurses have the ability to interact with patients… more
- Sharecare (Springfield, IL)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
- CVS Health (Atlanta, GA)
- …it all with heart, each and every day. **Position Summary** This Case Manager - Registered Nurse ( RN ) position is with Aetna's National Medical Excellence ... to apply, however, preference is for candidates in compact Registered Nurse ( RN ) states. This...is a blended role doing both Case Management and Utilization Management. The RN Case Manager is… more
- CVS Health (Madison, WI)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... in a hospital setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- MyFlorida (Tallahassee, FL)
- OPS REGISTERED NURSE - 64937233 Date: Jun 5, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 854396 Agency: Department of Health Working Title: OPS REGISTERED NURSE - 64937233 Pay Plan: Health Care Practice Position… more
- Saint Francis Health System (Tulsa, OK)
- …from ER, ICU, and CTU units. + All private rooms Job Summary: The Registered Nurse I assesses, plans, implements and evaluates nursing care, utilizing the ... therefrom. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: 0 - 6 months related… more
- Veterans Affairs, Veterans Health Administration (Aurora, CO)
- Summary This is an OPEN-CONTINOUS ANNOUNCEMENT. The Outpatient Mental Health Registered Nurse is responsible and accountable for all elements of the nursing ... basis and will remain on file through 9-30-2025. Initial review will be conducted within two weeks from the...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Insight Global (Philadelphia, PA)
- …Active RN License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review ) Strong computer skills Ability to ... looking for HEDIS RNs or LPNs for a partially remote contract position in PA and NJ. PARTIALLY ...Previous HEDIS review experience or experience with Utilization Review , Quality, Medical Record auditing Bachelors… more
- Ascension Health (Cedar Park, TX)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- AdventHealth (Orlando, FL)
- …environment. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse ( RN ) is to use clinical expertise by analyzing ... of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,...and valid license to practice in Florida as a Registered Nurse (ADN or BSN) required. +… more
- US Tech Solutions (Columbia, SC)
- …+ Skill sets/qualities: Must have at least 2 years hospital experience, any other utilization review experience is great, different areas of work is always a ... queue they work the incoming cases out of. They review the requested procedure against the criteria we use...with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member… more
- Intermountain Health (Murray, UT)
- …verified. + Case management Certification. + Experience in Case management, Utilization review , and/or discharge planning. **Physical Requirements:** + Ongoing ... for evenings, nights and weekends This position is not remote , working in office is required. **Job Essentials** +...and other patient care teams. **Minimum Qualifications** + Current RN license for state in which the nurse… more