- CVS Health (Austin, TX)
- …to make health care more personal, convenient and affordable. **Position Summary:** This Utilization Management (UM) Nurse Consultant role is fully remote and ... employee can live in any state. The UM Nurse Consultant job duties include (not all encompassing): +...encompassing): + Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization ,… more
- Community Health Network (Indianapolis, IN)
- Registered Nurse (RN) Case Manager / Utilization Review - North Emergency Job Ref 2408203 Category Nursing Job Family Case Manager Department Case ... a Difference** Community North has a part-time RN Case Manager / Utilization Review position available in the Emergency...Review position available in the Emergency Department. The Registered Nurse Case Manager is responsible for the… more
- Humana (Lexington, KY)
- …first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Nurse 2 who will utilize clinical nursing skills to support the coordination, ... determine appropriateness of services. The Utilization Management Nurse 2 will use clinical knowledge, communication...management experience in an acute care, skilled or Rehabilitation clinical setting. + Certified Case Manager (CCM)… more
- CVS Health (Phoenix, AZ)
- …a 24/7 operation.** Travel Required up to 5% for meetings/audits The Associate Manager is responsible for oversight of Utilization Management staff. This ... teams/ clinical liaisons, etc.) to ensure consistency in clinical interventions supporting our members. The Associate Manager...the needs of the department + 3+ years inpatient clinical experience as a Registered Nurse +… more
- VNS Health (Manhattan, NY)
- …or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state ... or an Occupational Therapist in New York State required + Certified Case Manager preferred + For SelectHealth ETE Only: Nurse Practitioner (NP) certification… 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
- Prime Healthcare (Weslaco, TX)
- …#registerednurse #casemanagement Connect With Us! (https://careers-primehealthcare.icims.com/jobs/188814/registered- nurse -case- manager utilization ... The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive… more
- Glens Falls Hospital (Glens Falls, NY)
- …can be foundhere. **Job:** **Nursing - Case Management* **Title:** *RN - Utilization Review Nurse * **Location:** *NY-Glens Falls* **Requisition ID:** *2410V* ... interdisciplinary team to support the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and… 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
- Community Health Systems (Franklin, TN)
- …appropriate additional documentation from the physician(s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians are unable ... UR Clinical Specialist communicates with Insurance providers and case manager (s) in person, telephonically, and/or through provider software to ensure effective… more
- Community Health Systems (Franklin, TN)
- …appropriate additional documentation from the physician(s). + Escalates cases to the Utilization Review Manager and/or Physician Advisor if physicians are unable ... Specialist. + In the event a facility does not have an ED Case Manager present, the UR Clinical Specialist will collaborate with Emergency Room Physician/staff… more
- Sharp HealthCare (San Diego, CA)
- …Will Do** As a member of the System Integrated Care Management (ICM) team the Utilization Manager (UM) II position supports utilization review functions to ... Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American Case… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical ... 8:00am-4:30pm Weekend and holiday rotations required **Job Description:** The Inpatient Registered Nurse (RN) Case Manager for Hospital at Home Care Transitions… more
- UNC Health Care (Chapel Hill, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in… more
- Independent Health (Buffalo, NY)
- …perks, benefits and commitment to diversity and inclusion. **Overview** The Program Manager - Utilization Management (UM) will be accountable for the management, ... IH associates on the use and implementation of new criteria. + Monitor utilization trends and clinical appropriateness and make changes (add/remove) in services… 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
- VNS Health (Manhattan, NY)
- …CEU credits, and advancement opportunities What You Will Do + Reviews specific utilization issues or requests with Clinical Review team, focusing on problem ... 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
- 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
- Virginia Mason Franciscan Health (Bremerton, WA)
- …EDUCATION AND EXPERIENCE** BSN (Bachelor of Science in Nursing) Minimum 5 years clinical experience as Registered Nurse (RN) Minimum 2 years managed care ... eligibility, and more! **Responsibilities** **JOB SUMMARY/PURPOSE** Provides leadership to Utilization Management RNs, Denials RNs and support staff to accomplish… more
- Mayo Clinic (Jacksonville, FL)
- …appropriate utilization management, care coordination, resource utilization , and clinical documentation. The RN Case Manager will function within the ... inclusion, and provides the resources you need to succeed. **Responsibilities** The Registered Nurse (RN) Case Manager works within an interdisciplinary team to… more
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