- Penn State Health (Hershey, PA)
- …PDF for more detailed steps for assistance._ **Union:** Non Bargained \#LI-TB1 **Position** Manager Utilization Management - DAY SHIFT - Utilization ... opportunity for individual highly skilled in utilization management **MINIMUM QUALIFICATION(S):** + Bachelor's Degree in Nursing...required + Currently licensed to practice as a registered nurse by Pennsylvania Board of Nurse Examiners… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review, under the supervision and in collaboration with ... applicable):** + State of Maryland license as a Registered Nurse + RN with BSN or RN with >...area. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + Knowledge of… more
- UCLA Health (Los Angeles, CA)
- …the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management ... RN licensure in CA required + Bachelors of Science, Nursing (BSN) degree required + Five or more years...(BSN) degree required + Five or more years of utilization management required + Four or more… 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 license… more
- Cleveland Clinic (Vero Beach, FL)
- … Manager . May design and initiate special projects as supervised by the Team Manager . Utilization Management Specialist Join our team at Cleveland Clinic ... of the most respected healthcare organizations in the world. Utilization Management (UM) Specialists perform UM activities,...nursing . + Current state licensure as a Registered Nurse (RN). + Basic Life Support (BLS) certification through… more
- Sharp HealthCare (San Diego, CA)
- …Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours** **:** **Shift Start ... management , utilization review, care coordination experience + California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED **Preferred… more
- Prime Healthcare (National City, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/180750/case- manager -rn utilization - management ... years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse ...experience preferred. At least one year experience in case management , discharge planning or nursing management… more
- Prime Healthcare (Montclair, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/181372/case- manager -%28rn%29 utilization - management ... years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse ...experience preferred. At least one year experience in case management , discharge planning or nursing management… 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
- Guthrie (Cortland, NY)
- …safe discharge, based on assessed needs and available resources. The Acute Case Manager also performs Utilization Management throughout the continuum of ... This is an integrated Case Management and Utilization Review position. The Acute Care Case Manager...Arts (BA) degree in addition to a degree in Nursing . A registered nurse with five (5)… 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
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. Under the direction of the Utilization Management , Assistant Manager , you will play a key role in processing ... reports and manage computer applications and logs + Monitor members/patients followed by Case Management + Work directly with a nurse team lead + Review pending… more
- Ellis Medicine (Schenectady, NY)
- …is to work with the Social Worker, Nurse Case Manager , or Utilization Management Nurse to facilitate patient discharge plans, support coordination of ... beneficiaries per CMS Conditions of Participation at the direction of the Case Manager . + Utilization Management Activities: + Collaborates with Case… more
- Sharp HealthCare (San Diego, CA)
- …System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center ... Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing...Experience and understanding of federal and state regulations governing utilization management . + Accredited Case Manager… more
- Sharp HealthCare (San Diego, CA)
- …Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American ... Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing...in Healthcare or a related field + 3 Years Utilization Management or case management … more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …prospective, and concurrent reviews. The Senior UM Coordinator reports to the Manager , Utilization Management and/or Supervisor, UM Coordinators. Primary ... About The Role Brighton Health Plan Solutions provides Utilization Management services to its clients. Senior UM Coordinators facilitate utilization review… 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, ... are 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
- 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 ... both) per the needs of the team.** The UM Nurse Consultant job duties include (not all encompassing): +...to coordinate, document and communicate all aspects of the utilization /benefit management program. + Utilizes clinical experience… 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
- Humana (Frankfort, KY)
- …Humana Healthy Horizons in Kentucky is seeking a Utilization Management Nurse 2 who will utilize clinical nursing skills to support the coordination, ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied… more
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