- VNS Health (Manhattan, NY)
- …Degree or equivalent work experience in management for a health plan or utilization / case management Required Master's Degree in Nursing or Health Care ... management or related field, including three years of progressive experience in case or utilization Management Required Effective oral/written communication and… more
- VNS Health (Manhattan, NY)
- …Professional Nurse or an Occupational Therapist in New York State required Certified Case Manager preferred For SelectHealth ETE Only: Nurse Practitioner (NP) ... cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in… more
- Actalent (Santa Barbara, CA)
- …Experience + Utilization Management WHAT'S IN IT FOR YOU: + Remote opportunity + Gain experience with a leading healthcare organization Description: The Health ... These units include, but are not limited to, the Utilization Management, Case Management, Enhanced Care Management,...Population Health programs. This position reports to the Program's Manager or their designee of the assigned unit. Depending… more
- Providence (Mission Hills, CA)
- **Description** The Manager of Utilization Management provides a...remote UR team + Previous experience as a case manager in an acute care setting ... hospital utilization management program in the Southern California Region. The Manager assists the Regional Director of Utilization Management, Appeals &… more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager (Ohio Resident)** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 **Job Brief** ... Degree. + Current and unrestricted RN license in OH. + 3+ years of utilization / case management experience in relevant scope preferred, one year required. + 3+… more
- Elevance Health (FL)
- **JR133557 Manager II Behavioral Health Services ( Utilization Management for Behavior Analysis Services)** Responsible for Behavioral Health Utilization ... department. Develops and manages annual operating budget. **Location:** This position will work remote and must live in Florida. **How will you make an impact:** +… more
- Humana (Columbus, OH)
- … case management and/or rehabilitative counseling experience required. Certified or certified-eligible case manager required. + 1 or more years of clinical ... and up to termination. + Care, Medicaid + Health plan experience + Certified Case Manager , CCM **Additional Information:** **Interview Format** As part of our… more
- Actalent (Tampa, FL)
- …them of referral status and relay updates to the assigned health plan case manager . + Participate in and contribute to ongoing quality assessment/improvement ... healthcare goals and care plans. + Use clinical expertise to review utilization information concerning patient care and match those needs to available care… more
- McLaren Health Care (Flint, MI)
- We are looking for a Case Manager RN to join us in leading our organization forward. McLaren Integrated HMO Group (MIG), a division of McLaren Health Care ... state providing services. + Two(2)yearsclinicalnursingexperience. + One (1) year previous case management or utilization review experience. _Preferred:_ + BSN.… more
- CVS Health (Richmond, VA)
- …regulations. . Identifies opportunities to develop training programs for the clinical case manager to ensure a thorough understanding of behavioral health ... providers. Serves as advocate for patients, ensuring effective communication, resource utilization , and continuous monitoring of their progress to promote positive… more
- Hackensack Meridian Health (Neptune, NJ)
- …Care Life Support HCP Certification. **Licenses and Certifications Preferred:** + Certified Case Manager (CCM), Certified Clinical Medical Assistant (CCMA), or ... leader of positive change. The **Care Management, Care Coordinator, Utilization Management** is a member of the healthcare team...New Jersey regulations for Nursing **.** **This is a remote , night shift position. The schedule for this role… more
- University of Michigan (Ann Arbor, MI)
- …etc. 3. Obtain authorization for services from third party payers and notify RN Case Manager of issues with authorizations 4. Enter authorization numbers and ... Utilization Management Assistant Apply Now **Mission Statement** Michigan...status 8. Answer departmental phones/messages and distribute to RN Case Managers mindful of coverage assignments. 9. Assist in… more
- The Cigna Group (Bloomfield, CT)
- …in TruCare and ICMS systems** **Within four (4) years of hire as a case manager will possess a URAC-recognized certification in case management.** ... **Nurse Case Management Lead Analyst - Remote -Full-Time**...for further management when appropriate.** **Must be skilled in utilization of Cigna resources when identifying need for further… more
- Providence (Mission Hills, CA)
- …in a remote UR environment or working as an acute hospital case manager . **Preferred Qualifications:** + Bachelor's Degree in Nursing. + Master's Degree ... **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records… more
- Health First (Viera, FL)
- *POSITION SUMMARY:* The RN Case Manager is fully engaged in providing quality/no harm, customer service and stewardship by utilizing advanced clinical skills in ... Florida regulations, and The Joint Commission (TJC) accreditation standards. The RN Case Manager uses sound clinical judgment, working collaboratively with the… more
- Mayo Clinic (Rochester, MN)
- …care coordination, resource utilization , and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional ... Case Manager provides leadership through education on case management/ utilization management concepts, committee work, research, and community… more
- Elevance Health (Louisville, KY)
- …or equivalent and a minimum of 3 years acute care clinical experience or case management, utilization management or managed care experience; or any combination ... ** Utilization Management Nurse (RN)** **$3,000 SIGN ON BONUS OFFERED** **Location** : Remote opportunity. Must reside in the state of Kentucky. The **… more
- CVS Health (Trenton, NJ)
- …to make health care more personal, convenient and affordable. **Position Summary:** This is a remote Case Manager opportunity with 50 to 75% field travel in ... writing and communication skills are required. **Fundamental Components/Job Description:** The Case Manager is responsible for conducting face to face… more
- International Medical Group (Indianapolis, IN)
- …visa status (eg, H-1B or TN status) for this position. JOB SUMMARY The Case Manager will evaluate medical necessity, appropriateness, and efficiency of the use ... in good standing in Indiana. + Location: Hybrid or Remote working options. + Corporate office is in Indianapolis,...of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison… more
- CVS Health (Trenton, NJ)
- …make health care more personal, convenient and affordable. **Position Summary** This is a ** remote ** Clinical Case Manager opportunity with 50 to 75% field ... writing and communication skills are required. **Fundamental Components/Job Description:** The Clinical Case Manager BH is responsible for conducting face to… more