- ERP International (Corpus Christi, TX)
- **Overview** ERP International is seeking a **Registered Nurse (RN)** ** Utilization Manager ** for a full-time position in support of the **Naval Health ... assessment, planning, implementation, coordination, and monitoring. * Collect and analyze clinical utilization data to identify information on resource… more
- Dartmouth Health (Lebanon, NH)
- Overview The Manager of Utilization Management is responsible for day to day operations of the utilization review program at multiple Dartmouth Health system ... These are just a few highlights of being a nurse at Dartmouth Hitchcock Medical Center and Clinics in...Oversees workflow related to patient status determinations. * Identifies clinical areas that require intervention and education, works closely… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN 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 LVN II will...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Humana (Louisville, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied and… 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)
- …us one of America's Best Hospitals! **What You Will Do in This Role:** The Utilization Review Case Manager validates the patient's placement to be at the most ... the patient's expected length of stay. The UR Case Manager secures authorization for the patient's clinical ...employment. **Req ID** : 5044 **Working Title** : Registered Nurse - Utilization Management 8 Hour Days… more
- Veterans Affairs, Veterans Health Administration (St. Louis, MO)
- …St. Louis Health Care System (VASTLHCS), St. Louis, Missouri. The Registered Nurse Case Manager ( Utilization Management) demonstrates leadership, experience, ... Total Rewards The primary purpose of this Registered Nurse Case Manager (RNCM) is to deliver...to protect and improve patient and staff safety. Applies clinical knowledge/judgment to lead staff involvement in planning, decision-making,… more
- Elevance Health (Tampa, FL)
- …in the state of Florida. + Requires minimum of 5 years acute care clinical experience, utilization management or managed care experience; or any combination of ... Senior RN Utilization Review/Management (Acute InPatient) JR116937 **Location:** Must be...Friday. **2 Holidays** per year and **occasional** weekends. The ** Nurse Medical Management Sr** serves as **team lead** for… 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
- 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
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …the Medical Director when appropriate, according to policy\. + Assists non\- clinical staff in performance of administrative reviews + Performing comprehensive ... and UM pre\-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility\. + Occasional weekend work may… more
- UNC Health Care (Hillsborough, NC)
- **Description** RN Utilization Manager is responsible for clinical reviews for medical necessity for both admission and continuing stay patients during the ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …improvement activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection; ... patient services/procedures. Communicates with review organizations/payers to provide requested clinical and psychosocial information to assure reimbursement. UTILIZATION… more
- WellSpan Health (York, PA)
- Utilization Care Manager Location: York Hospital, York, PA Schedule: Part Time Hours: M-F Days Part Time: 20 hours/week General Summary Performs a variety of ... effective and quality treatment. Assists in the organizing of utilization reports and revision of clinical policies... of resources to the attention of the appropriate manager (s). + Prepares and maintains appropriate documentation as required.… more
- Molina Healthcare (NV)
- **JOB TITLE : Manager , Healthcare Services** **This position supports our NEVADA health plan. Nevada residents preferred. Applicants who do not live in Nevada will ... state at this time.** **Prior experience with managed care (Medicaid, Medicare) Utilization Management processes and 3 + years in management / staff oversight… more
- AdventHealth (Altamonte Springs, FL)
- **Senior Manager of Utilization ** **-AdventHealth Well65** **All the benefits and perks you need for you and your family:** . Benefits from Day One . Paid Days ... at a practice)** **The role you'll contribute:** The Senior Manager of Utilization will oversee ED, Inpatient,...in nursing with 4 years of experience. . Registered Nurse with an active and unrestricted license to practice… 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
- Immigration and Customs Enforcement (Miami, FL)
- …Enforcement (ICE), ICE Health Service Corps (IHSC), Office of Deputy Assistant Director of Clinical Services (DAD-CSU). The Nurse Manager (NM) will report ... directly to the Regional Nurse Manager (RNM) with the Chief Nurse (CN)...national, state, and local nursing laws and regulations. Maintains clinical professional skills via continuing education opportunities and … more
- Trinity Health (Silver Spring, MD)
- …an acute healthcare setting required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At least 5-7 ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Manager Care Mgt & Util Review **Employment Type:** Full Time **Shift:** Day… more
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