- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- Commonwealth Care Alliance (Boston, MA)
- …responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting ... & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the… more
- Penn Medicine (Lancaster, PA)
- …each day. Are you living your life's work? Summary: + Position Summary: The Utilization Management Specialist - Denials is responsible for evaluating medical ... Minimum Required Qualifications: + Current licensure as a Registered Nurse , issued by the Pennsylvania Board of Nursing +...structures and related legal medical issues. + Knowledge of utilization management and quality improvement processes. +… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of ... in an acute care setting. Required 1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse (RN) State And/Or Compact… more
- Katmai (Fort Carson, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... licensed in Colorado, be able to practice using a nurse compact state license or have a license from...checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional… more
- LifePoint Health (Louisburg, NC)
- …job field* **Organization:** **Maria Parham Franklin* **Title:** *Registered Nurse Utilization Review Coordinator* **Location:** *NC-Louisburg* **Requisition ... Registered Nurse (RN) Utilization Review Job Type:...of those we serve. Connect with our RN recruiting specialist . Do you need more time to complete an… more
- Nuvance Health (Danbury, CT)
- …36 Shift: 9am-930pm; including every 3rd weekend rotation Summary: The purpose of the Utilization Management Nurse is to support the physician, the ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews… more
- LA Care Health Plan (Los Angeles, CA)
- Managed Long Term Services and Supports Nurse Specialist RN II Job Category: Clinical Department: Managed Long Term Services and Supports Location: Los Angeles, ... Summary The Managed Long Term Services and Supports (MLTSS) Nurse Specialist RN II applies advanced clinical...and must adhere to regulatory mandates that apply to Utilization Management (UM) and Care Management… more
- MyFlorida (Marianna, FL)
- REGISTERED NURSE SPECIALIST - 67039438 (SUNLAND NURSING - ALL SHIFTS) Date: Jun 11, 2025 The State Personnel System is an E-Verify employer. For more information ... Agency: Agency for Persons with Disabilities Working Title: REGISTERED NURSE SPECIALIST - 67039438 (SUNLAND NURSING -...dynamics. This position with APD will serve staff and management across the Agency. Your work will impact the… more
- Veterans Affairs, Veterans Health Administration (Coatesville, PA)
- …Responsibilities The Nurse Quality Management (QM) Consultant Registered Nurse (RN) Accreditation Specialist focuses on individual growth and development ... qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: Experience in utilization management reviews and/ or accreditation. Physical… more
- MyFlorida (Macclenny, FL)
- REGISTERED NURSE SPECIALIST - 60011390 Date: Jun 11, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... No: 854733 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST - 60011390 Pay Plan: Career...Ability to analyze complex reports and determine the service utilization habits of clients and to evaluate the appropriateness… more
- MyFlorida (Orlando, FL)
- 6804236 - REGISTERED NURSE SPECIALIST Date: Jun 7, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... Agency: Agency for Health Care Administration Working Title: 6804236 - REGISTERED NURSE SPECIALIST Pay Plan: Career Service Position Number: 68048236 Salary:… more
- MyFlorida (Clearwater, FL)
- 68064198 - REGISTERED NURSE SPECIALIST Date: Jun 9, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... for Health Care Administration Working Title: 68064198 - REGISTERED NURSE SPECIALIST Pay Plan: Career Service Position...individual, team member or team leader. As assigned by management , this position is required to successfully complete the… more
- Rush University Medical Center (Chicago, IL)
- …an integrated role of practice, education, administration and research. The Clinical Nurse Specialist exemplifies the Rush mission, vision, and values and ... disability, veteran status, and other legally protected characteristics. **Position** Clinical Nurse Specialist | Neonatal ICU **Location** US:IL:Chicago **Req… more
- Ochsner Health (New Orleans, LA)
- …Louisiana Registered Nurse (RN) License Preferred - Certification in Case Management (CCM) or Certified Professional in Utilization Review, Utilization ... to all medical necessity audits. **Education** Required - Registered Nurse Diploma Preferred - Associate's or Bachelor's degree in...of patient care as an RN. Experience in Case Management , Utilization Review and/or Discharge Planning .either… more
- Cambridge Health Alliance (Cambridge, MA)
- Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry **Requisition Number:** CHAP-2270 **Cambridge Health Alliance (CHA)** , a well-respected, ... is required authorizing practice in an expanded role as a Psychiatric Nurse Clinical Specialist and authorization including prescriptive authority. _In keeping… more
- AdventHealth (Orlando, FL)
- …ROLLINS STREET, Orlando, 32803 **The role you'll contribute:** **The Care Transitions Registered Nurse ensures that a care plan is carried out in partnership with ... various other teams, including but not limited to Care Management nurses and social workers, nursing, home care liaisons,...high risk for readmission or for high emergency room utilization . Follows up with patients at location of post… more
- AdventHealth (Orlando, FL)
- …125,000 outpatients each year **The role you'll contribute:** **The Care Transitions Registered Nurse ensures that a care plan is carried out in partnership with the ... various other teams, including but not limited to Care Management nurses and social workers, nursing, home care liaisons,...high risk for readmission or for high emergency room utilization . Follows up with patients at location of post… more
- Ascension Health (Pensacola, FL)
- …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... of the department and assists with the budgeting process. + Serve as content specialist for staff in the areas of utilization criteria, appeal and review… more
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... **Job Summary** The Clinical Utilization Review Specialist is responsible for...extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key… more