- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is ... service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key...work may be required on a rotational basis; some travel to home office may be required. **Required Education… more
- NewYork-Presbyterian (Brooklyn, NY)
- …Completing concurrent and retrospective reviews - Communicating with physicians and the inpatient case management teams on patients who do not meet initial ... applicant will need are listed in the following description. Case Manager - RN - Inpatient Units-...case manager/discharge planning, certified home health care (CHHA), Case Management experience, utilization experience, or managed… more
- Katmai (Usaf Academy, CO)
- **SUMMARY:** Performs healthcare coordination and case management activities IAW Medical Treatment Facility (MTF) instructions. **ESSENTIAL DUTIES & ... Accreditation of Healthcare Organizations(JCAHO), Ambulatory Health Care (AAAHC) & Case Management Society of America (CMSA)). +...States or jurisdiction, be able to practice using a nurse compact state license or Enhanced Nurse … more
- Somatus (Miami, FL)
- …and mental well-being + Community engagement opportunities + And more! Field Based Nurse Case Managers are an important part of the interdisciplinary care ... communication with members via in-person or on-phone interaction + Travel to complete in home and in facility visits...experience + Field-based experience going into homes + Telephonic case management experience + Experience working within… more
- UnitedHealthcare (New Orleans, LA)
- …RN licensure in the state of Louisiana 3+ years of experience as a Registered Nurse in a hospital setting, acute care, direct care experience, community ... high-speed internet service Preferred Qualifications: Bachelor's degree Certification in Case Management (CCM) Field-based work experience Experience with… more
- NewYork-Presbyterian (New York, NY)
- …field * Fluency in Spanish Required Criteria * Bachelors degree in Nursing (BSN) * Current NYS Registered Nurse ( RN ) licensure * 3 to 5 years of health care ... and supporting information regarding this job opportunity. Care Manager- RN - Inpatient Unit- Columbia Day Shift Weekends -...and one weekday. Preferred Criteria * 2 years of case management /care coordination experience in an inpatient,… more
- UnitedHealthcare (Columbus, OH)
- …may be interested in. Required Qualifications: * Current, unrestricted independent licensure as a Registered Nurse in Ohio * 2+ years of clinical experience as ... and read the complete job description before applying. The RN Clinical Care Coordinator will be the primary care...Field * CCM certification * 1+ years of community case management experience coordinating care for individuals… more
- UnitedHealthcare (Union, NJ)
- …may be interested in. Required Qualifications: Current, unrestricted independent licensure as a Registered Nurse 2+ years of clinical experience 1+ years of ... pertaining to this job in the description below. The RN Clinical Care Coordinator will be the primary care...in clinical field CCM certification 1+ years of community case management experience coordinating care for individuals… more
- University of New Mexico - Hospitals (Albuquerque, NM)
- …experience, education, and other business and organizational considerations. Department: Care Management Services Do you have the following skills, experience and ... Full Time Shift: Days Position Summary: Supervise clinical therapy, social work, and case manager social work staff. Responsible for the initial review, triage and… more
- UnitedHealthcare (Kaunakakai, HI)
- …reliable transportation Preferred Qualifications: * Bachelor's degree or higher * CCM (Certified Case Manager) * Case Management experience * Experience with ... as you take on some tough challenges. Position requires travel about 75% of the time locally. Primary Responsibilities:...may be interested in. Required Qualifications: * Current, unrestricted RN license in the state of Hawaii * 2+… more
- UnitedHealthcare (White Plains, NY)
- …years of relevant clinical work experience 1+ years of experience of community case management experience coordinating care for individuals with complex needs ... associated information and make sure to apply. In this RN Field Clinical Care Manager role, you will be...right services to meet their needs. There will be travel expectations throughout advertised boroughs. If you are located… more
- UnitedHealthcare (New York, NY)
- …of relevant clinical work experience * 1+ years of experience of community case management experience coordinating care for individuals with complex needs * ... us to start Caring. Connecting. Growing together. In this RN Field Clinical Care Manager role, you will be...right services to meet their needs. There will be travel expectations throughout advertised boroughs. If you are located… more
- Terumo Neuro (Aliso Viejo, CA)
- …education and experience. 2. Registered Radiologic Technologist (RT) CV, VI, CI, Registered Nurse ( RN ) or Endovascular, Cardiac background with a minimum ... experience in neuro endovascular therapies as a technologist or nurse preferred. 3. Minimum of three (3) years of... travel to hospitals and participate in clinical case coverage. 6. Understanding of project management ,… more
- Terumo Neuro (Aliso Viejo, CA)
- …education and experience. 2. Registered Radiologic Technologist (RT) CV, VI, CI, Registered Nurse ( RN ) or Endovascular, Cardiac background with a minimum ... focus on knowledge of neuro anatomy and physiology. 4. Capability and flexibility to travel to hospitals and participate in clinical case coverage. 5. Strong… more
- Terumo Medical Corporation (Caguas, PR)
- …facilities to provide direct occupational health support. **Qualifications/ Background Experiences** Registered Nurse ( RN ) with active professional licensure ... Occupational Health Nurse Date: Nov 20, 2025 Req ID: 5323...threshold changes are tracked and required follow-ups are completed. Case Management and Return-to-Work Processes - Actively… more
- Molina Healthcare (Madison, WI)
- …graduate from an accredited school of nursing, must have an active and unrestricted Wisconsin Registered Nurse ( RN ) license in good standing. * Valid and ... a background in human services, social work, healthcare or case management to join our team. This...reliable transportation, and adequate auto insurance for job related travel requirements. * Attention to detail and ability to… more
- Huntington Ingalls Industries (Newport News, VA)
- …contagious diseases or serious injuries to company or employees physician. Must be a Registered Nurse ( RN ). May work with industrial toxicology and/or ... NURSE EMPLOYEE HEALTH 3/BLS, PFT QUALIFIED Location: Newport...available Virtual/Telework Opportunity: No - Not eligible for telework Travel Requirement: No Clearance Required: No - Clearance Not… more
- Harbor Health Services, Inc. (Mattapan, MA)
- …than 580 participants. We are currently seeking a Director of Utilization Management & Quality Programs. Harbor Health offers an excellent, comprehensive benefits ... Director of Health Plan Operations, the Director of Utilization Management and Quality Programs is responsible for the day-to-day...gaps in care that may affect utilization. Performs clinical case reviews of high utilization cases and those upon… more
- Commonwealth Care Alliance (Boston, MA)
- …does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management - Serve as the primary relationship manager and point of contact ... - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal teams as needed.… more
- Ascension Health (Evansville, IN)
- …hire. **Additional Preferences** + One year of **recent** experience in Case Management required. + Local and national travel options are available depending ... **Details** + Weekly Travel Rate up to $1,693-$2,590 + **Department:** Associate...post-discharge care. **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date… more
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