- Medical Solutions (Omaha, NE)
- Take control of your career with this Case Management ( Utilization Review ) in RN ( Registered Nurse) job in Baltimore, MD. Enjoy freedom, flexibility, and ... industry-leading service from a company that truly cares. Whether you're...to make sure it's amazing! Our travelers enjoy top-tier service from their own dedicated recruiter, thousands of jobs… more
- BridgePoint Healthcare (Washington, DC)
- …and discharge planning. Case Management, RN Case Manager, RN CCM, RNCM, RN CM, Utilization Review , Hospital Case Management, Registered Nurse Case Manager ... throughout the continuum of care and ensures optimum utilization of resources, service delivery, and compliance with external review agencies. The RN Case… more
- Contra Costa County, CA (Martinez, CA)
- … Services ? The Contra Costa Health Department is seeking to fill one (1) Utilization Review Manager position in Contra Costa Health Plan, located in Martinez, ... (D-SNP) lines of business. We are seeking a strategic, experienced, and collaborative Utilization Review Manager to lead our Utilization Management… more
- AmeriHealth Caritas Health Plan (Washington, DC)
- …to efficiently document and assess patient cases Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... compliance Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment The range displayed in this job… more
- NYC Health Hospitals (New York, NY)
- …conduct the orientation of new employees. 5. Supervision of staff of the Utilization Management Department. 6. Determine, outline, and review daily assignments ... staff of the Utilization Management Department. 7. Plan, prepare, manage, review , and approve the Time and Leave Schedule, including Annual Leave, Sick Leave,… more
- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- … review , and transitions to prevent readmissions. Liaise with medical staff, utilization review , social services , payors, and community providers. Track ... department budget, staffing, and training needs. Function as Utilization Review /Denials Manager as required. Qualifications Registered Nurse (RN) with a… more
- UnitedHealth Group (San Antonio, TX)
- …letters to provider and member May provide guidance and coaching to other utilization review nurses and participate in the orientation of newly hired ... of the Optum family of businesses, is seeking a Registered Nurse RN Medical Claims Review Healthcare...50-state license) 2+ years of experience in managed care, Utilization Review , Case Management OR 5+ years… more
- Ochsner Health (New Orleans, LA)
- …hospital-based experience in discharge planning, case management or utilization review . Certifications Required - Current registered nurse license in state ... to change at the company's discretion. Education Required - Registered nurse diploma or equivalent. Preferred - Bachelors degree...of the conditions of participation as it relates to utilization review and discharge planning. Maintains open… more
- Baptist Health Care (Gulf Breeze, FL)
- Job Description The Utilization Review Nurse acts as a patient and organizational advocate. An autonomous role that coordinates, negotiates, procures services ... of resources across the continuum of care. The Utilization Review Nurse assists the nurse case...years broad based nursing experience Required Licenses and Certifications Registered Nurse Licensed State of Florida or eligible compact… more
- Veterans Health Administration (Reno, NV)
- Summary The Nurse II Utilization Management (UM) Registered Nurse (RN) is responsible for providing competent, evidence-based practices within the position. Uses ... owe allegiance to the US Federal employees - Excepted service Current federal employees whose agencies have their own...level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board… more
- NYULMC (New York, NY)
- …top five in the nation. NYU Langone offers a comprehensive range of medical services with one high standard of care across 6 inpatient locations, its Perlmutter ... Summary: We have an exciting opportunity to join our team as a Registered Nurse, Pediatric/Neonatal Transport, Per Diem. In this role, the successful candidate… more
- Molina Healthcare (Long Beach, CA)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... and cost-effective based on the severity of illness and the site of service . KNOWLEDGE/SKILLS/ABILITIES Assesses services for members to ensure optimum outcomes,… more
- Bayfront Health (St. Petersburg, FL)
- … Management Plan. Integrates National standards for care management scope of services including: Utilization Management supporting medical necessity and denial ... Site: Orlando Health Bayfront Hospital - St. Petersburg, Florida Position: Registered Nurse Care Manager Schedule: Full-time About Orlando Health Bayfront Hospital… more
- Accede Solutions, Inc. (Glendale, CA)
- Registered Nurse - Case Management Duration:13 Weeks Start:03/10/2025 Job Type: Travel Minimum Guaranteed Hours: 40 Jobs Notes: Day Shift, inpatient RN CM Acute ... Planning. We are comprised of a 515-bed hospital, two urgent cares, home care services , comprehensive cardiology care and a vast scope of services . Job Summary:… more
- Prisma Health (Columbia, SC)
- …of care and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan. - 10% Promotes effective and efficient utilization ... the difference. Job Summary The Hospital Case Manager (HCM) provides case management service for hospital patients, including, but not limited to, utilization … more
- Acadia Healthcare (Moosic, PA)
- …about various physical and behavioral health conditions. *Provide nursing care and services within the standards and scope of nursing practice as defined within ... initial treatment plan is completed upon admission. *Demonstrate knowledge and utilization of universal precautions in providing direct patient care. *Accurately… more
- Northwestern Memorial Healthcare (Mchenry, IL)
- …and all other regulatory and accreditation standards. A clinically competent, registered , professional nurse who prescribes, delegates and coordinates nursing care ... toward attainment of outcomes. Directs care and determines the appropriate utilization of any assistant involved in providing direct patient care. Collaborates… more
- Saint Francis Health System (New Haven, CT)
- …needed by the department; limited benefit offerings. Nights Job Summary: The Registered Nurse I assesses, plans, implements and evaluates nursing care, utilizing the ... Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: 0 - 6 months related experience.… more
- Orlando Health (Orlando, FL)
- …care, surgical intervention, intensive and general acute care, rehabilitative services , behavioral health, social services , community re-integration plans, ... quality and appropriateness of patient care and safety of the air transport service *Assist with the accreditation process. Responsible to coordinate or assist in… more
- Team Select Home Care (Miami, FL)
- …Control Plan, EMS Plan and the Compliance Plan Participates in clinical record/ utilization review of medical records and quality assurance and performance ... heart, more flexibility, and more purpose? Join Team Select Home Care as a Registered Nurse (RN), where you'll bring comfort and confidence to families by delivering… more
