- Sharp HealthCare (San Diego, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... compliance with all local, state and federal regulations governing utilization review activities and/or care management...clinical experience as defined by the CBA. + California Registered Nurse ( RN ) - CA… more
- Stanford Health Care (Palo Alto, CA)
- …leading process redesign work necessary to implement improvements. + Directs the utilization management , concurrent review , prior authorizations medical ... onsite Stanford Health Care job.** **A Brief Overview** The Dir- Utilization Management (UM) leads and shapes the...in nursing (MSN) + Current unrestricted license as a Registered Nurse issued by the state of… more
- Centene Corporation (Jefferson City, MO)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... care, provider interactions, and facilitates operations within utilization management . + Manages prior authorization, concurrent review , and retrospective… more
- Centene Corporation (Phoenix, AZ)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure… more
- Corewell Health (Grand Rapids, MI)
- …years of relevant experience Knowledgeable of compliance and regulations as it relates to Utilization Preferred + Registered Nurse State of MI, Requires upon ... Job Summary - Director, Utilization Management The Director, Utilization...in the development of new policies and procedures annual review of policies and procedures. + Develops and implements… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …educational training for medical staff on issues related to utilization management . 1. Implements utilization review policies and procedures. 2. ... eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for...Educates and trains staff on utilization review processes and guidelines. 3. Promotes… more
- Point32Health (Canton, MA)
- …leading, and modifying the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, ... perform the job** **Education, Certification and Licensure** + Master's degree preferred. + RN ( Registered Nurse ) with unrestricted MA license preferred. +… more
- Fairview Health Services (St. Paul, MN)
- …role (grandfather status) + Current RN licensure in MN + 3-5 years utilization review or case management experience in hospital, clinic, insurance ... **Overview** M Health Fairview has an immediate opening for a Utilization Management Specialist RN . This position provides comprehensive assessment,… more
- McLaren Health Care (Detroit, MI)
- …and implementing process improvement projects as needed. _Required:_ + State licensure as a registered nurse ( RN ) + Bachelor's degree in nursing from ... **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm**...established SOP procedures. 4. Maintains current knowledge of hospital utilization review processes and participates in the… more
- Hackensack Meridian Health (Brick, NJ)
- …community resources, and utilization management + NJ State Professional Registered Nurse License required + AHA Basic Health Care Life Support HCP ... to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator** , ** Utilization Management ** is a member of… more
- CVS Health (Columbus, OH)
- …work the following schedule:** **Monday-Friday 8:00am-4:30pm EST.** **Position Summary** As a Utilization Management Nurse Consultant, you will utilize ... (Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** -1+ years' experience Utilization Review experience -1+ years' experience Managed Care -… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- Hackensack Meridian Health (Holmdel, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to.... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- Hackensack Meridian Health (Edison, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The Case Management Care Coordinator, Utilization Management is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to... Licenses and Certifications Required: + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- McLaren Health Care (Port Huron, MI)
- …related duties as required and directed. **Qualifications:** Required ⦁ State licensure as a registered nurse ( RN ) ⦁ Bachelor's degree in nursing from ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- Hackensack Meridian Health (Hackensack, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The Case Management Care Coordinator, Utilization Management is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to... Licenses and Certifications Required: + NJ State Professional Registered Nurse License + AHA Basic Health… more
- CDS Life Transitions (Webster, NY)
- Summary: Utilization Management Reviewer (UR) is the...+ Bachelor's degree in Nursing + State licensure as a Registered Nurse ( RN ) + Minimum 2 ... of controlling costs and monitoring quality of care. The Utilization Management Reviewer will play...by supervisor. + Acts as Subject Matter Expert in Utilization Review and medical necessity criteria +… more
- Veterans Affairs, Veterans Health Administration (Aurora, CO)
- …care to Veterans? Responsibilities The Utilization Management (UM) Registered Nurse ( RN ) executes position responsibilities that demonstrate ... application of UM methods and expertise in medical necessity review criteria. The UM RN is a...knowledge of clinical appropriateness, functions, processes, and principles of utilization management . They must have strong interpersonal… 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 ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more