- Molina Healthcare (Houston, TX)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- UCLA Health (Los Angeles, CA)
- …clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays...vital role in ensuring the delivery of high-quality, evidence-based care . This position is responsible for reviewing and evaluating… more
- Dignity Health (Bakersfield, CA)
- …experience. - Graduate of an accredited RN Program. - Clear and current CA Registered Nurse ( RN ) license. - Knowledge of nursing theory and ability to ... customer service in line with CommonSpirit's values. You will function as a UM nurse reviewer, applying clinical expertise to ensure appropriate healthcare… more
- Veterans Affairs, Veterans Health Administration (Milwaukee, WI)
- …care levels along the care continuum. Responsibilities The Utilization Management ( UM ) Registered Nurse ( RN ) executes position responsibilities ... Summary The Utilization Management ( UM ) Registered Nurse ( RN ) is...to evolving Utilization Management standards. Experience with Optum InterQual review process preferred. Health Care and quality… more
- Elevance Health (Cerritos, CA)
- **Behavioral Health Care Manager II, UM ** **Location:** California **Virtual:** This role enables associates to work virtually full-time, with the exception of ... 8:30 am - 5:00 pm PST The **Behavioral Health Care Manager II** is responsible for managing psychiatric and...outpatient professional treatment health benefits through telephonic or written review . This role is a part of the team… more
- Healthfirst (NY)
- …or equivalent work experience + NYS RN + Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations ... concurrent review , and service requests + Lead, coach, and develop UM managers overseeing interdisciplinary teams of registered nurses, social workers,… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Preferred: + Master's Degree. Licenses and Certifications Preferred: NJ State Professional Registered Nurse License or NJ Licensed Social Worker. 175164 Minimum ... knowledge and understanding of behavioral health resource management to review and coordinate the care for a...care . Education, Knowledge, Skills and Abilities Required: + RN , BSN, or Bachelors degree in a clinical field… more
- Trinity Health (Columbus, OH)
- …as appropriate. Assists in the implementation of Case Management software along with the Plan's UM and QM Program and the review of the Plan's Medical Management ... United States. We're dedicated to providing excellent customer service, cost-effective care , and exceptional healthcare coverage. We rely on talented colleagues in… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE (Ambulatory Care Nurse Resource Pool-Cancer Center Cluster) Apply Now **Mission Statement** Michigan Medicine improves the health of ... equal employment opportunity employer. **Job Detail** **Job Opening ID** 272501 **Working Title** REGISTERED NURSE (Ambulatory Care Nurse Resource… more
- University of Michigan (Ann Arbor, MI)
- …Nurse Recruitment at ###. **Required Qualifications Current Michigan Registered Nurse License. 12-24 months of current PICU RN experience PALS ... to deliver the safest and highest quality of health care . Applicants are expected to review the...**Job Opening ID** 272704 **Working Title** REGISTERED NURSE (Mott Childrens Hospital-10W, Pediatric Cardio Thoracic Intensive Care… more
- Cedars-Sinai (CA)
- …as a condition of continued employment. **Req ID** : 13443 **Working Title** : Registered Nurse Care Coordinator- Inpatient Specialty Program - 8 Hour ... they are discharged from the hospital by assessing their needs, coordinating care , communicating with health plans, including concurrent review to determine… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE (Mott Childrens Hospital-10W, Pediatric Cardio-Thoracic Unit GN Internship) Apply Now **Job Summary** This position is a 6-month internship ... to deliver the safest and highest quality of health care . Applicants are expected to review the...employer. **Job Detail** **Job Opening ID** 272705 **Working Title** REGISTERED NURSE (Mott Childrens Hospital-10W, Pediatric Cardio-Thoracic… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of ... First Refusal (ROFR) requests, review of Specialty Care Referrals, sustaining up-to-date Specialty Clinic Referral Review...RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an… more
- Katmai (Fort Carson, CO)
- …Degree of Nursing. + Current, full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate from a college or university ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management ( UM )...years within the last four (4) years as a registered nurse in utilization management. + One… more
- US Tech Solutions (Wichita, KS)
- …and implementation of QM Work Plan Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in state of residence + Must have prior ... CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . +... Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:**… more
- University of Miami (Miami, FL)
- …please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Registered Nurse works as a part of a ... team to provide quality care to designated patients. The RN works...are not limited to: Performance Nursing Duties as per Nurse Job Description 100% Perform patient interview and obtains… more
- ERP International (Luke AFB, AZ)
- **Overview** ERP International is seeking a full time ** Registered Nurse - Case Management** in support of the56th Medical Group at Luke AFB, AZ ... **Be the Best!** Join our team of exceptional health care professionals across the nation. Come discover the immense...full, active, and unrestricted license to practice as a Registered Nurse , any state. Clinical Certification:** Certified… more
- University of Miami (Miami, FL)
- …not require direct physician involvement as per physician orders and within the scope of RN licensure 7. Renders dire ct patient care by assisting providers with ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Sign on Bonus:… more
- Molina Healthcare (Tacoma, WA)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- LA Care Health Plan (Los Angeles, CA)
- …for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted California ... Utilization Management Nurse Specialist RN II Job Category:...timelines as defined by the most current department policy. Facilitate/ review requests for Higher level of care … more