- Healthfirst (NM)
- …case management, identifying alternative care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of ... **This position is 100% Remote **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes: + Pre-certification… more
- Pacific Medical Centers (Seattle, WA)
- …patient in order to assure cost effective, appropriate utilization of health care resource. UM Nurse Case Manager perform utilization management of services ... Qualifications:** + Bachelor's Degree in Nursing. + Upon hire: Certified Case Manager . **Why Join Providence?** Our best-in-class benefits are uniquely designed… more
- Molina Healthcare (Long Beach, CA)
- …Certified Clinical Coder + Certified Medical Audit Specialists (CMAS) + Certified Case Manager (CCM) + Certified Professional Healthcare Management (CPHM) ... The **Delegation Oversight Nurse** is responsible for ensuring that Molina Healthcare's UM delegates are compliant with all applicable State, CMS, and NCQA… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …part time with full benefits with a remote work option. The Medical Director, UM is a clinical subject-matter expert for the Utilization Management Team and shall ... assist in the oversight of all UM activities. This position serves as a resource to...in areas of clinical quality, practice patterns, utilization management, case management, and patient satisfaction. This position is accountable… more
- Highmark Health (Carson City, NV)
- …industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans ... :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over… more
- The Arora Group (Bethesda, MD)
- Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse (RN) Case Manager to work the Directorate of Healthcare Operations (DHO) at ... period will be provided one month in advance. DUTIES OF THE REGISTERED NURSE CASE MANAGER (RN): The contracted RN shall provide the following services and… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible for functional and operational aspects of the Case Mgmt./Social Work ... corporate and hospital administrators, medical staff, and defined customers related to the Case Mgmt. system. The Manager Case Mgmt./Social Work position… more
- ERP International (Port Hueneme, CA)
- **Overview** ERP International, LLC is seeking a **Registered Nurse - Case Manager ** for a full-time position supporting **Branch Health Clinic Port Hueneme, ... for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management with...for professional growth and development as related to the case manager position and maintenance of CM… more
- HCA Healthcare (Lake City, FL)
- …at HCA Florida Lake City Hospital have the opportunity to make a real impact. As a(an) Case Manager RN PRN you can be a part of change. **Benefits** HCA Florida ... improve positive outcomes for your patients as a (an) Case Manager RN PRN. We want your...condition and insurance company request and documents in the UM module. + Performs initial screening of identified patients… more
- Omaha Children's Hospital (Omaha, NE)
- …team to assess for diagnosis, care needs, and discharge plans. + Introduces Nurse Case Management (NCM) role to family. + Completes NCM assessment and documents in ... improvement and processes. Communicates and collaborates with the Utilization Management ( UM ) Nurse, or other NCMs as necessary to provide information relating… more
- University of Michigan (Ann Arbor, MI)
- RN CASE MANAGER : (Care Management- D. Dan and Betty Kahn Health Care Pavilion ) Apply Now **Job Summary** The RN Case Manager assesses, develops, ... effective utilization of resources while promoting quality outcomes. **Organizational Relationships** The RN Case Manager reports directly to the Manager of… more
- Covenant Health (Nashua, NH)
- …and duplication of care and enhancing quality, cost-effective clinical outcomes. The RN Case Manager works closely with, and delegates care to, the High-Risk ... procedures. + Maintains/enhances professional development/skills required to function as a Case Manager and fulfills organizational requirements (ie, data entry,… more
- University of Michigan (Ann Arbor, MI)
- Student Support Case Manager Apply Now **How to Apply** A cover letter is required for consideration for this position and should be attached as the first page ... to their experience within the University. The Student Support Case Manager reports to the Director of...preferably in a higher education setting + Familiarity with UM policies, procedures, and organizational structure **Modes of Work**… more
- ERP International (Twentynine Palms, CA)
- …of the following certifications: (Must obtain within 18 months of employment.) o Commission for Case Manager Certification Certified Case Manager (CCM) o ... for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management with...Rehabilitation Counselor (CRC) o American Nurses Credentialing Center Nurse Case Manager (RN-NCM) o National Academy of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- Job Description: Summary: Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for ... for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program… more
- ERP International (Eglin AFB, FL)
- **Overview** ERP International is seeking a **Registered Nurse (RN)** for a full-time ** Case Manager ** position in support of the **Eglin Hospital, Eglin AFB, FL ... databases for community resources. + Integrate CM and utilization management ( UM ) and integrating nursing case management with social work case management. +… more
- Lakeview NeuroRehabilitation Center (Waterford, WI)
- …a member of the Case Management Team, consisting of the Lead Case Manager , the MD Chair of the UM committee, the Medical Social Worker, and other ... The Scope of Practice for the RN Case Manager includes responsibility for management of the assigned patient population through multidisciplinary team… more
- Virginia Mason Franciscan Health (Seattle, WA)
- …(5) years of nursing experience. Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferredAble to apply clinical ... multiple stakeholders Professional communication skills. Understand how utilization management and case management programs integrate. Ability to work as a team… more
- Covenant Health (Lewiston, ME)
- …your skills and experience as it relates to the position. Summary The UR Case Manager conducts medical necessity reviews per the Utilization Management ( UM ... admissions, patients on observation, and outpatients in a bed. The UR Case Manager identifies delays in care and documents and communicates findings with the… more
- Stony Brook University (Stony Brook, NY)
- RN Case Manager **Position Summary** At Stony Brook Medicine, a **TH Staff Associate/ Case Manager ** is a valuable member of our team, who provides ... high standard of excellence. **Duties of a TH Staff Associate/ Case Manager in the Care Management Department...their work and follow up with cases. **Preferred:** CM, UM , Quality, Coding, Risk or MCG Certification Working knowledge… more