• Utilization Management Nurse

    WellSpan Health (York, PA)
    Utilization Management Nurse ( RN ) - Case Management - Day (Temporary) Location: WellSpan Health, York, PA Schedule: Full Time Schedule Temporary ... General Summary Performs a variety of reviews and applies utilization and case management techniques...administration or management . Preferred Licenses: + Licensed Registered Nurse Upon Hire Required or +… more
    WellSpan Health (01/24/25)
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  • Episodic Utilization Case Manager…

    Healthfirst (NY)
    RN , LPN, LMSW, LMHC,LMFT, LCSW, PT, OT, and/or ST license + For Episodic Utilization / Case Management : NYS RN or Licensed Social Worker (LCSW/LMSW any ... **Duties/Responsibilities:** + Provides case management services for assigned member...with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community… more
    Healthfirst (11/24/24)
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  • Appeals Manager, Department of Utilization

    BronxCare Health System (Bronx, NY)
    …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients,… more
    BronxCare Health System (12/18/24)
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  • Director of Case Management

    Scottish Rite for Children (Dallas, TX)
    …We're committed to giving children back their childhood! Job Posting Title: Director of Case Management and Utilization Management Location: Dallas - ... Details: Monday - Friday 8:00am to 4:30pm Job Description: Duties/Responsibilities: + Utilization Management supporting medical necessity and denial prevention +… more
    Scottish Rite for Children (11/11/24)
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  • Utilization Analyst Case

    Beth Israel Lahey Health (Burlington, MA)
    …Description:** The Utilization Analyst works with physicians, the payers and inpatient case management team to validate the medical necessity of the hospital ... care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these specialized case managers analyze medical… more
    Beth Israel Lahey Health (01/15/25)
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  • Registered Nurse ( RN )…

    Matrix Providers (Aurora, CO)
    Registered Nurse ( RN ) - Utilization Management Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... is hiring a Registered Nurse ( RN ) - Utilization Management to...and 12 months consecutive experience in utilization management , utilization review or case more
    Matrix Providers (11/26/24)
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  • RN , Utilization Management

    Trinity Health (Philadelphia, PA)
    …Nazareth Hospital, a member of Trinity Health Mid-Atlantic, is seeking experienced Utilization Management RN to join the Case Management team! ... general supervision of the Manager of Utilization Management , the Utilization RN assists...License + Two years of clinical experience, which includes utilization or case management experience… more
    Trinity Health (01/17/25)
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  • Utilization Review Case Manager

    Morris Hospital (Morris, IL)
    …experience in acute hospital setting. + Strong clinical expertise. + Prior experience in utilization management or case management preferred. + Ability ... + Professional/Educational + Bachelor's degree required in a healthcare related field. + Case management certification preferred (eg CCM, ACM, CPUM). + Minimum… more
    Morris Hospital (01/11/25)
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  • RN Utilization Manager - Rex…

    UNC Health Care (Raleigh, NC)
    …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... medical discharge planning issues, continuing care needs by initiating appropriate case management referrals. Initiates appropriate social work referrals. 3.… more
    UNC Health Care (01/15/25)
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  • Registered Nurse

    Aspen Medical (Aurora, CO)
    JOB AD: Registered Nurse - Utilization Management Introduction : Aspen Medical has an exciting opportunity for Registered Nurses to partner with us in ... patient care clinical setting. Must have utilization management , utilization review or case ...full, active, and unrestricted license to practice as a Registered Nurse as required in the TO… more
    Aspen Medical (01/22/25)
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  • Case Manager with Utilization Review…

    Beth Israel Lahey Health (Burlington, MA)
    …Full Time Days 8:00am-4:30pm Weekend and holiday rotations required **Job Description:** The Inpatient Registered Nurse ( RN ) Case Manager for Hospital at ... making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse...a timely process. Registered Nurses (RNs) with utilization review experience, case management more
    Beth Israel Lahey Health (01/15/25)
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  • Case Manager Registered Nurse

    RWJBarnabas Health (Livingston, NJ)
    Case Manager Registered Nurse - Case Management (FT/Days)Req #:0000179789 Category:Nursing Status:Full-Time Shift:Day Facility:Cooperman Barnabas ... Short Hills Road, Livingston, NJ 07039 Job Summary: The Case Manager Registered Nurse will...hospital setting + Minimum of one year experience in Case Management / Utilization Management more
    RWJBarnabas Health (12/12/24)
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  • Utilization Management Nurse

    LA Care Health Plan (Los Angeles, CA)
    Utilization Management Nurse Specialist RN ...an acute hospital setting. At least 2 years of Utilization Management / Case Management ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
    LA Care Health Plan (01/24/25)
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  • Director Case Management

    Brockton Hospital (Brockton, MA)
    …while optimizing resource utilization . Provides training to staff on case management methods and techniques. Establishes monitoring mechanisms to identify ... and develops reports that clearly monitor all areas of utilization / case management . Provides data, guidance...RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts… more
    Brockton Hospital (12/13/24)
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  • Registered Nurse - Case

    WellSpan Health (York, PA)
    Registered Nurse - Case Management -...General Summary Performs a variety of duties and applies utilization and case management techniques to ... patient discharge needs. Provides leadership in the integration of utilization and case management principles...., or Clinical Nursing Specialty. Preferred Licenses: + Licensed Registered Nurse Upon Hire Required or +… more
    WellSpan Health (01/07/25)
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  • Utilization Management Nurse

    Actalent (Santa Barbara, CA)
    Job Title: Health Plan Nurse Coordinator Non-profit healthcare network is looking for a utilization management registered nurse to join their team on ... Health Plan Nurse Coordinator (HPNC) is a Registered Nurse who is assigned to one...These units include, but are not limited to, the Utilization Management , Case Management more
    Actalent (01/23/25)
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  • Utilization Management Spec…

    Fairview Health Services (St. Paul, MN)
    **Overview** **Fairview Health Services is hiring a casual** ** Utilization Management Spec RN ** **to join our Revenue Cycle Management team. This is a ... **Required** + Bachelor's degree in Nursing + 3-5 years Utilization Review or Case Management ...years of acute care hospital nursing experience. + Current RN License **Preferred** + Minimum of 1-year Epic experience.… more
    Fairview Health Services (01/23/25)
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  • Utilization Management RN

    Pacific Medical Centers (Renton, WA)
    Registered Nurse License. + 5 years Clinical experience. + Utilization review/ case management . **Preferred Qualifications:** + Bachelor's Degree in ... effective, appropriate utilization of health care resource. Utilization Nurse / Case Manager...outpatient. This position assists physicians (internal and external) with management and coordination of care. Works primarily at Renton… more
    Pacific Medical Centers (01/23/25)
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  • Corporate Director of Clinical Utilization

    Prime Healthcare (Ontario, CA)
    …or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan + ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Corporate Director of Clinical Utilization Management (UM) provides comprehensive… more
    Prime Healthcare (11/28/24)
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  • Utilization Management Nurse

    CVS Health (Austin, TX)
    Nurse ​ **Preferred Qualifications** + Clinical experience in post-acute setting + Prior utilization review or case management experience + Managed Care ... or other events, as directed by their Leader. - Utilization Management is a 24/7 operation and...**Required Qualifications** + Must have active current and unrestricted RN licensure in state of residence + May be… more
    CVS Health (01/25/25)
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