- CHRISTUS Health (Wake Village, TX)
- Description Summary: The Registered Nurse Clinical Care Coordinator is responsible for evaluating, coordinating, processing, screening, and documentation of ... patient entry into the CHRISTUS Health System. The Registered Nurse Clinical Care Coordinator will collaborate with relevant providers and partners to determine… more
- UPMC (Hanover, PA)
- **UPMC is hiring a Professional Care Manager to support the Utilization Review process! This is a full time, day shift position with a rotating weekend and ... position is eligible for a generous Sign on Bonus! _** **Purpose:** The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs… more
- Prime Healthcare (Weslaco, TX)
- …#rnweekendstaff #casemanagement Connect With Us! (https://careers-primehealthcare.icims.com/jobs/183021/registered- nurse -case- manager utilization ... KNAPP MEDICAL CENTER IS LOOKING FOR A PRN REGISTERED NURSE CASE MANAGER TO WORK WEEKENDS. WE...designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a… more
- 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 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Cedars-Sinai (Los Angeles, CA)
- **Job Description** **Job Summary: Key Job Responsibilities** The Utilization Review Case Manager validates the patient's placement to be at the most appropriate ... the patient's expected length of stay. The UR Case Manager secures authorization for the patient's clinical ...Coordination **Req ID** : 1074 **Working Title** : Registered Nurse - Utilization Management - Per Diem… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management/ clinical /or combination; 2 of 4 years ... + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and… more
- Travelers Insurance Company (Buffalo, NY)
- …Imagine loving what you do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual base salary range ... Is the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective,… more
- Pipeline Health System, LLC (Toast, NC)
- Job Title: Utilization Review Registered Nurse - Behavioral Health Unit/FT/Days Job Summary: This Utilization Review (UR) Registered Nurse (RN) position ... and compassionate care to our patients. This position is responsible for utilization review, assessment of discharge planning needs and coordination of effective… more
- Elevance Health (Los Angeles, CA)
- …care clinical experience is required. **Preferred Qualifications** + Previous utilization review/ utilization management experience in a managed care setting ... Mesa, Los Angeles, Rancho Cordova, Sacramento, Walnut Creek, Woodland Hills** The Nurse Medical Management I is responsible to collaborate with healthcare providers… more
- The Cigna Group (Bloomfield, CT)
- …issues, implications and decisions. The Case Management Analyst reports to the Supervisor/ Manager of Appeals and will coordinate and perform all appeal related ... limited to: + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C...as well as research and provide a written detailed clinical summary for the Plan Medical Director. + Determine… more
- Sharp HealthCare (San Diego, CA)
- …Professional (AHA BLS Healthcare) - American Heart Association; California BBS Licensed Clinical Social Worker (LCSW) - CA Board of Behavioral Sciences; California ... (LMFT) - CA Board of Behavioral Sciences; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours**...CA Board of Registered Nursing **OR** California BBS Licensed Clinical Social Worker (LCSW) - CA Board of Behavioral… more
- UNC Health Care (Raleigh, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... **Description** **Full time on-site staff Utilization Manager ** Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to… more
- Sharp HealthCare (San Diego, CA)
- …Degree in Nursing; Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered ... patient care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/ utilization review demands to assure… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Commonwealth Care Alliance (Boston, MA)
- …the area of service decisions and organizational determinations.The Manager , Utilization Management reports to the Director of Clinical Effectiveness. **What ... services,procedures, and facilities under the provisions of CCA's benefits plan.The Manager , Utilization Management is responsible for overseeing and managing… more
- VNS Health (Manhattan, NY)
- …general supervision. Compensation Range:$98,200.00 - $130,800.00 Annual * Reviews specific utilization issues or requests with Clinical Review team, focusing ... OverviewManages the utilization management team to ensure that standards for...and mitigate any discerned risks. * Facilitates and schedules Clinical Rounds to establish best practice and promote creative… more
- Magellan Health Services (Boise, ID)
- …experience. Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and ... solutions that directly influence quality of care. General Job Information Title Care Manager (SUD utilization review preferred) - REMOTE USA Grade 24 Work… more
- Johns Hopkins University (Lutherville, MD)
- …Department of Otolaryngology is seeking a **_CO_** **_Clinical Nurse Manager_** the Clinical Nurse Manager collaborates with the Medical Director and ... to improve workflows. + Resolves scheduling conflicts, monitors room utilization , and maintains clinic patient flow at each clinic...to two years of required nursing experience. Classified Title: Clinical Nurse Manager Job Posting… more
- Humana (Salem, OR)
- …a part of our caring community and help us put health first** The Manager , Utilization Management Nursing utilizes clinical nursing skills to support ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific guidelines… more
- Providence (Mission Hills, CA)
- …Southern California Region. The Manager assists the Regional Director of Utilization Management, Appeals & Clinical Training through the provision of ongoing ... **Description** The Manager of Utilization Management provides a...patient admission, transfers, and discharges in a variety of clinical settings. Accomplishes results through multiple experienced individual staff… more
