- Trusted Resource Associates (TRA) (Palm Springs, CA)
- …greater level of Contract security compared to with an outside agency. The RN Case Manager is responsible to facilitating care along a continuum through ... Associates (TRA) is seeking a local contract nurse RN Utilization Review for a local contract nursing job in...with a payer on a case by case basis.Schedule: - This is a remote … more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …certification: 12 months full-time case management experience supervised by a certified case manager , or 24 months full-time case management experience ... patient needs; Works collaborate with the Physicians, patient/family, nursing, utilization review and other members of the healthcare team...not supervised by a certified case manager . Minimum Experience: Three (3) to five (5) years… more
- Pacer Staffing (Atlanta, GA)
- Shift - Standard | Mon to Fri Location - Remote ( Case Manager - serious diagnoses. Children/Pediatric with down syndrome, serious disabilities, physical ... complex case management services from a non-ECHO case manager . Maintains knowledge of and compliance...and build group engagement. Technical Skills: Thorough knowledge of Case Management, Utilization Management, TRICARE policies and… more
- Pacer Staffing (Atlanta, GA)
- …regulatory requirements, and HIPAA privacy regulations. . Thorough knowledge of Case Management, Utilization Management, HIPAA Privacy and Security regulations. ... . Onsite: Works within a standard office environment . Remote : Private and secure workspace and workstation with high-speed...Minimum of three years clinical experience . Experience in case management, care coordination or discharge planning in an… more
- Cambia Health Solutions, Inc (Lewiston, ID)
- …direct clinical care.Must have at least one of the following: Certification as a case manager from the URAC-approved list of certifications; or Bachelor's degree ... Associates or Bachelor's Degree in Nursing or related field3 years of case management, utilization management, disease management, or behavioral health … more
- Merck & Co. (Lenexa, KS)
- …both domestically and internationally.The primary responsibilities of the Customer Marketing Manager are to lead all marketing and advertising initiatives and ... with Farm/Ranch retailers.- Help solve customer problems through the utilization of our company's products, services, and sales tools...pose an undue burden to business operations, in which case you may not be offered employment, or your… more
- Merck & Co. (North Wales, PA)
- …key priorities for our Company is a significant focus-on Data and its utilization as a Strategic asset to drive insights-driven decisions. The opportunity to ... Services team's mission is to focus on driving these capabilities to increase utilization of data within the organization.How will you invent the future?-We have an… more
- Cambia Health Solutions, Inc (Lewiston, ID)
- …of direct clinical careMust have at least one of the following:Certification as a case manager from the URAC-approved list of certificationsMaster's degree in a ... Health (for behavioral health care management) or related field3 years of case management, utilization management, disease management, or behavioral health … more
- Healthfirst (NY)
- …case management, identifying alternative care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of ... **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which...with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community… more
- Henry Ford Health System (Detroit, MI)
- …equipment. + Innovative Team Structure:Benefit from our new dyad Social Work/RN Case Manager model and remote utilization review setup, allowing you to ... environment? Join our team as a Registered Nurse (RN) Case Manager ! Who We're Looking For: Passionate,...level of care seamlessly. Perks of the Role: + Remote Flexibility:After 6 months, enjoy the option to work… more
- AdventHealth (Altamonte Springs, FL)
- …Care (TOC) process to ensure quality and consistency. The Senior Manager of Utilization will liaise with RN Case Managers to assist primary care physicians, ... **Senior Manager of Utilization ** **-AdventHealth Well65** **All...you'll bring to the team:** . Develops and implements case management programs and education, including utilization … more
- Molina Healthcare (Seattle, WA)
- …Clinical Social Worker (LCSW) + Advanced Practice Social Worker (APSW) + Certified Case Manager (CCM) + Certified in Health Education and Promotion (CHEP) ... with the adult behavioral health system in Washington State and** ** Utilization Management experience is highly preferred.** **_Further details to be discussed… more
- University of Miami (Miami, FL)
- … Utilization Management, has an exciting opportunity for an Utilization Review Case Manager to work remote . The incumbent conducts initial, concurrent ... chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare team for optimal… more
- CVS Health (Columbus, OH)
- …local community networks and resources. + Crisis intervention skills + Managed care/ utilization review experience + Case management and discharge planning ... care more personal, convenient and affordable. **Position Summary** This a fulltime remote Transition of Care coordination opportunity. It is a non- member facing… more
- Banner Health (Tucson, AZ)
- … remote and hybrid work settings. In the role of a Behavioral Health Utilization Care Manager , you will be tasked with assignments at various hospitals to ... 5:00 pm Arizona Time Zone. The position is fully remote ; however, **Arizona residency is required for compliance purposes**...SUMMARY This position is the point person for all utilization activities for assigned members. As part of an… more
- Elevance Health (Topeka, KS)
- ** Manager of Utilization Review - Kansas** **Location:** This position will work a hybrid model ( remote and office). Must reside in Kansas and within 50 ... Elevance Health location (Olathe, Kansas City, or Topeka). The ** Manager of Utilization Review** is responsible for...an impact:** + Manages and oversees team responsible in case finding and coordinating cases that involve comorbid conditions.… more
- Molina Healthcare (Long Beach, CA)
- …a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG ... can be flexible and willing to work some weekends and holidays. This is a remote position and you may work from home. Please consider that scheduling flexibility is… more
- The Cigna Group (Austin, TX)
- …in TruCare and ICMS systems** **Within four (4) years of hire as a case manager will possess a URAC-recognized certification in case management.** ... **Bilingual Nurse Case Management Lead Analyst - Remote -Full-Time**...for further management when appropriate.** **Must be skilled in utilization of Cigna resources when identifying need for further… more
- Humana (Louisville, KY)
- …Management experience in an acute care, skilled or Rehabilitation clinical setting + Certified Case Manager , CCM + Health Plan experience + Medicaid experience + ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Health First (Melbourne, FL)
- *POSITION SUMMARY:* The RN Case Manager is fully engaged in providing quality/no harm, customer service and stewardship by utilizing advanced clinical skills in ... Florida regulations, and The Joint Commission (TJC) accreditation standards. The RN Case Manager uses sound clinical judgment, working collaboratively with the… more
