- Independent Health (Buffalo, NY)
- …perks, benefits and commitment to diversity and inclusion. **Overview** The Program Manager - Utilization Management (UM) will be accountable for the ... assess and make recommendations for improvements to maintain an effective and efficient utilization management process, as well as manage medical expenses based… more
- VNS Health (Manhattan, NY)
- …experience in management for a health plan or utilization /case management Required + Master's Degree in Nursing or Health Care Administration Preferred ... OverviewManages the utilization management team to ensure that...and current registration to practice as a registered professional nurse in New York State Required + Valid driver's… more
- VNS Health (Manhattan, NY)
- …and updates through on-going training, coaching and educational materials. + For Utilization Management Only: + Issues Determinations, Notices of Action, and ... by state or federal regulations are saved in the Utilization Management System. + Reviews, evaluates and...Therapist in New York State required + Certified Case Manager preferred + For SelectHealth ETE Only: Nurse… more
- Prime Healthcare (Weslaco, TX)
- …#registerednurse #casemanagement Connect With Us! (https://careers-primehealthcare.icims.com/jobs/188814/registered- nurse -case- manager utilization - ... in a related field. At least one year experience in case management , discharge planning or nursing management ;2. CCM or obtained within 6 months of hire.3.… more
- Trinity Health (Philadelphia, PA)
- …Full-time, 40hrs/wk, Monday-Friday day shift. **:** Under the general supervision of the Manager of Utilization Management , the Utilization RN ... a member of Trinity Health Mid-Atlantic, is seeking experienced Utilization Management RN to join the Case...management . **Minimum Qualifications:** + BSN or BA in Nursing + PA RN License + Two years of… more
- UNC Health Care (Raleigh, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection...and obtains observation status as appropriate. Partners with physicians, nursing , and other care providers to help ensure timely… more
- BronxCare Health System (Bronx, NY)
- …and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients, ... includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more
- Stanford Health Care (Palo Alto, CA)
- …practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, ... + Knowledge of principles and best practices of case management , utilization review, social work, care coordination...effective plan to address them. **Licenses and Certifications** + Nursing / RN - Registered Nurse -… more
- Elevance Health (Tampa, FL)
- …health plans for people enrolled in Medicaid and/or Medicare programs in Florida. ** Manager II GBD Special Program** **Location:** This position will work a hybrid ... days may be required based on operational needs. The ** Manager II GBD Special Program** is responsible for supporting...operations in support of corporate and health plan UM management . + Directs and collaborates with functional managers to… more
- LA Care Health Plan (Los Angeles, CA)
- …Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range ... the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and… more
- Community Health Systems (Siloam Springs, AR)
- **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities under the ... supervision of a Registered Nurse or physician. This role involves reviewing medical records...clinical nursing experience required + Experience in utilization review, case management , or discharge planning… more
- Children's Hospital Boston (Boston, MA)
- …Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Office/Site Location:BostonRegular, Temporary, Per Diem:Per Diem ... 74825BRJob Posting Title:Registered Nurse Case Manager , Inpatient & Ambulatory...length of stay, resource allocation, funding sources, and capacity management to optimize delivery of appropriate services. + Actively… more
- Actalent (Sacramento, CA)
- …are nurses, licensed marriage family therapists, or certified professional counselors. The Case Manager will perform utilization management by applying MCG ... Job Title: Licensed Vocational Nurse Job Description The Case Manager ...as TMS, ECT, and neuropsychiatric testing. Responsibilities + Perform utilization management by applying MCG criteria or… more
- Penn Medicine (Philadelphia, PA)
- …their critical thinking skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, ... fearful you will miss patient contact? If so, our nurse case manager role at Penn Medicine...community resources, transportation, and quality data collection and risk management referral. + Responsibilities: Utilization management… 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...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- UPMC (Hanover, PA)
- …(CM) coordinates the clinical and financial plan for patients. Performs overall utilization management , resource management , discharge planning and ... **UPMC is hiring a part time Professional Care Manager for our Utilization Review department...required with 4-6 weeks of hire. UPMC approved Care Management certification preferred. + Registered Nurse (RN)… more
- Actalent (Santa Barbara, CA)
- …Title: Health Plan Nurse Coordinator Non-profit healthcare network is looking for a utilization management registered nurse to join their team on a ... with a leading healthcare organization Description: The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse ...and professional nursing standards of practice Skills: Utilization Management , Medi-Cal, Medicare, RN, health plan… more
- Texas Health Resources (Arlington, TX)
- **RN/Registered Nurse - Utilization Management , Clinical Reviews** **Work location:** 100% remote but must live in Texas, preferably in the Dallas-Fort Worth ... an acute hospital setting required and + 1 Year Utilization Management required and + Experience in...criteria preferred **Licenses and Certifications** + RN - Registered Nurse Current license to practice professional nursing … more
- Guthrie (Sayre, PA)
- …to day operational leadership, oversight, and support to the Acute Case Managers, nurse utilization management team, medical social workers and ... and cost- effective manner. The Manager -of Case Management supports utilization management , discharge...a supervisory or lead role. Education Bachelors degree in nursing is required. Must successfully obtain/maintain a pass rate… more
- US Tech Solutions (Columbia, SC)
- …8:30am - 5pm. No 10hr schedules available at this time. + From the Manager : -Experience: Hospital experience, UM experience + Description: office work, at a desk 8 ... established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and… more
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