- University Health (Pleasanton, TX)
- …(as a Staff nurse II or above). Work experience in case management , utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS Current ... POSITION SUMMARY/RESPONSIBILITIES The nurse case manager coordinates, in collaboration... Nurse with the Texas State Board of Nurse Examiners is required. An approved case management… more
- Mercy (Dexter, MO)
- …practice for Registered Nurse . Experience: Minimum three years nursing experience. Previous leadership/ management experience preferred. Certifications: BLS, ... Find your calling at Mercy! Responsible for assisting the Chief Nursing Officer in the delivery of safe, quality and cost efficient care by having competent staff… more
- University Health (Hondo, TX)
- …years of clinical nursing experience is required. Data entry, referral management , utilization management experience is required. Case Management ... outcomes, compliance, and decrease complications. EDUCATION/EXPERIENCE Graduation from an accredited school of nursing , RN or LVN is required. A minimum three… more
- University Health (Boerne, TX)
- …years recent, full time hospital experience preferred. Work experience in case management , utilization review, or hospital quality assurance experience is ... and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to… more
- University Health (Pleasanton, TX)
- …Three years recent, full-time hospital experience preferred. Work experience in case management , utilization review or hospital quality assurance experience is ... skills for serving in the liaison roles with medical staff, nursing , and patients and families. EDUCATION/EXPERIENCE Graduation from an accredited school… more
- Elevance Health (Washington, DC)
- …office 4 days each week. The office is located at 609 H. Street NE.** The ** Manager of Utilization Management ** **ll** is responsible for managing a team of ... acuity. + Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member...+ Assists and provides back up coverage to Case Management team **Minimum Requirements:** + BA/BS in Nursing… more
- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Nov 30, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling ... care and their communities. Role Overview: The role of Utilization Management Manager oversees the...for this role will have a bachelor's degree in nursing , public administration, public policy, public health or related… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- Huron Consulting Group (Chicago, IL)
- …Join our team as the expert you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, ... Review Plan and the overall operation of the Utilization Management Department in accordance with federal,...goals. **Requirements** + BSN is required. Master's Degree in nursing or related field preferred. + 5 years recent… more
- Guthrie (Sayre, PA)
- …approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of ... Arts (BA) degree in addition to a degree in Nursing . A registered nurse with five (5)...admissions and short procedures by translating clinical information to Utilization Management requirements using pre ‐ determined… more
- Actalent (Duluth, GA)
- Case management & Utilization management registered nurse opportunity! Description Nurse will be working on site. Responsibilities will include: Case ... Manager / Utilization Management (90%) and Discharge... Manager / Utilization Management (90%) and Discharge Planning. Develop...At least 1 year of case management /care management Must be a RN (Registered Nurse )… more
- Corewell Health (Grand Rapids, MI)
- …of insurance prior authorizations, initial reviews, continuous stay reviews and appeals. Nurse Care Manager - Plans and prioritizes care for individuals ... optimal health within populations. Demonstrates expertise, current knowledge in nursing care and management of a caseload...management /managed care or related field Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required… more
- UPMC (Pittsburgh, PA)
- Are you a registered nurse with a background in utilization management ? UPMC Health Plan is looking for you! We are hiring a full-time Utilization ... Management Care Manager to support the Utilization Management Clinical Operations Department. This position...2 years of experience in a clinical and/or case management nursing required. + Minimum of 1-year… 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
- Community Health Systems (Bentonville, AR)
- …live! **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
- Billings Clinic (Billings, MT)
- …issues, escalates to Supervisor, Manager , or Director * Insurance and Utilization Management * Maintains working knowledge of CMS requirements and ... manager staff provide services consisting of comprehensive case management , care coordination, continuing care services, and clinical social...assigned patients * Attends 1400 afternoon huddles with charge nurse and nurse care manager … more
- Houston Methodist (Houston, TX)
- …of hospital clinical nursing experience, which includes three years in utilization review and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position...to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse ...Quality) to resolve escalations and address utilization management issues. + Represent UM nursing team ... Nurse license EXPERIENCE: + Minimum 3 years of nursing experience in acute, outpatient, or managed care setting....or managed care setting. + Minimum 2 years of utilization management experience in a payer or… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the ... Revenue, Billing, Insurance Verification, Veteran Services, Compliance, Providers, Health Information Management (HIM), Utilization Management (UM), and… more
- AmeriHealth Caritas (Philadelphia, PA)
- …us at www.amerihealthcaritas.com . **Responsibilities:** Under the supervision of the LTSS Manager /Director for Utilization Management , this position is ... Home Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and operational… more
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