- Harbor Health Services, Inc. (Mattapan, MA)
- …and organization management In-depth knowledge of all aspects of managed care medical management including UM /CM, Grievance and Appeals, inpatient and ... improvement plans, and assess outcomes. Promotes the appropriate use of InterQual's medical management treatment guidelines. Ensures controls are established to… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, ... medical directors/physician reviewers, network physicians, and network facilities to...most appropriate course of action + Provides education to nurse and therapist reviewers regarding appeal updates and process… more
- Commonwealth Care Alliance (Boston, MA)
- …Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key...Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy +… more
- Katmai (Fort Carson, CO)
- …or American Red Cross. + Three (3) years within the last four (4) years as a registered nurse in utilization management . + One (1) year of experience in UR/ ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management ( UM ) program for all TRICARE eligible...full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate… more
- ERP International (Luke AFB, AZ)
- …is seeking a full time ** Registered Nurse - Case Management ** in support of the56th Medical Group at Luke AFB, AZ ... databases for community resources. - Integrate CM and utilization management ( UM ) and integrating nursing case ...full, active, and unrestricted license to practice as a Registered Nurse , any state. Clinical Certification:** Certified… more
- ERP International (Hurlburt Field, FL)
- **Overview** ERP International is seeking a full time ** Registered Nurse ( RN ) Case Manager** in support of the 1st Special Operations Medical Group at ... Management Specialist (CDMS) Association of Rehabilitation Nurses: Certified Rehabilitation Registered Nurse (CRRN) American Board for Occupational Health… more
- ERP International (Twentynine Palms, CA)
- **Overview** ERP International is seeking ** Registered Nurse ( RN ) Case Managers** for full-time positions in support of the **Naval Hospital Twentynine ... Management Specialist (CDMS) o Association of Rehabilitation Nurses: Certified Rehabilitation Registered Nurse (CRRN) o American Board for Occupational Health… more
- ERP International (Tinker AFB, OK)
- **Overview** ERP International, LLC is seeking a ** Registered Nurse - Case Manager** for a full-time position supporting **SHG Clinic** in support of **Tinker ... no limitations, stipulations or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction. Security** : Must possess… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …knowledge of different claim types is desired. (Preferred) + Current Washington State License: Registered Nurse ( RN ), Advanced Registered Nurse ... and updating appropriate procedure and diagnosis codes for company medical policies and UM (Utilization Management ) guidelines that reflect medical… more
- Stony Brook University (Stony Brook, NY)
- …communication skills while adhering to our high standard of excellence. **Duties of a RN Case Manager in the Care Management Department may include the following ... assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Katmai (Usaf Academy, CO)
- …and provides upon request. + Reports monthly summary of care to Director, Medical Management (MM) or designee. + Conducts monthly evaluation, in conjunction ... **SUMMARY:** Performs healthcare coordination and case management activities IAW Medical Treatment Facility...and civilian healthcare providers and staff and uses Utilization Management ( UM ) systems support to identify high-risk/high-cost… more
- Alameda Health System (Oakland, CA)
- …background. Required Licenses/Certifications : Valid license to practice as a Registered Nurse in the State of California. Preferred Licenses/Certifications ... : UM / CM certifications Highland General Hospital SYS Utilization Management Full Time Day Nursing FTE: 1 more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical… more
- Elevance Health (Richmond, VA)
- …integration, and ensures essential face-to-face onboarding and skill development._ The ** Medical Management Clinician Sr** is responsible for ensuring ... types that require the training and skill of a registered nurse . Acts as a resource for...efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and applies… more
- UPMC (Pittsburgh, PA)
- UPMC Home Health is Hiring a Full-Time Registered Nurse ( RN ) for the Uniontown and Surrounding Areas Are you a nurse looking for a rewarding career where ... patients' plans of care in collaboration with physicians, patients, and utilization management ( UM ) professionals to meet physicians' orders and patients' needs.… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : Ambulatory Care Services (Ambulatory Care Nurse Resource Pool-Surgical Specialties) Apply Now **How to Apply** This is a "multiple-fill" ... and pediatric Surgical Specialty patients in multiple Surgical Specialty ACU?s. The Registered Nurse demonstrates adaptability to changing needs and priorities… more
- Providence (Olympia, WA)
- …strong clinical background blended with well-developed knowledge and skills in Utilization Management ( UM ), medical necessity and patient status ... determination. This individual supports the UM program by developing and maintaining effective, efficient processes...must empower them. **Required Qualifications:** + Upon hire: Washington Registered Nurse License + 3 years of… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE (Cardiovascular Answer Line) Apply...years). + RN experience as a charge nurse or equivalent management skills + Bilingual ... opportunity employer. **Job Detail** **Job Opening ID** 271586 **Working Title** REGISTERED NURSE (Cardiovascular Answer Line) **Job Title** REGISTERED… more
- Ivyhill Technologies LLC (Bethesda, MD)
- … management process and the RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an unencumbered active RN license ... Ivyhill is currently seeking to hire a Registered Nurse (Non-Practicing) to support its...management systems. Will conduct reviews for capacity, capability, medical necessary, deferral to network, and right of first… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : University Hospital (5A Ortho/Trauma Surgical Unit) Apply Now **Mission Statement** Michigan Medicine improves the health of patients, ... opportunity employer. **Job Detail** **Job Opening ID** 263217 **Working Title** REGISTERED NURSE : University Hospital (5A Ortho/Trauma Surgical Unit) **Job… more
