- University Health (Boerne, TX)
- …Three years recent, full time hospital experience preferred. Work experience in case management , utilization review , or hospital quality assurance experience ... clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF...of the State of Texas to practice as a registered nurse is required. National certification in… 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 ... Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred....of the State of Texas to practice as a registered nurse is required. National certification in… more
- 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 licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Katmai (Fort Carson, CO)
- …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/UM and ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management...full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate… more
- Centene Corporation (Sacramento, CA)
- …degree and 4+ years of related experience. Knowledge of utilization management principles preferred. Must have a CA RN License **License/Certification:** + ... ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks... RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare...Operational oversight of centralized and site-specific UM teams, including utilization review nurses and support staff. Cultivate… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- State of Indiana (Indianapolis, IN)
- …The role of Utilization Management Manager oversees the integration of utilization review , clinically appropriate care and risk management for the ... Utilization Management Manager Date Posted: Nov...and clinical criteria evaluations.They will possess a current unrestricted RN license from the State of Indiana; a minimum… more
- McLaren Health Care (Port Huron, MI)
- …related duties as required and directed. **Qualifications:** Required ⦁ State licensure as a registered nurse ( RN ) ⦁ Bachelor's degree in nursing from ... **Department:** Utilization Review **Daily Work Times:** 8:00am-4:30pm...Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure… more
- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Waystar (Atlanta, GA)
- …end user adoption of best practice workflows. We are specifically seeking an experienced Utilization Review Nurse who will serve as an integral contributor ... **ABOUT THIS POSITION** The Clinical Product Consultant for Utilization Management is a member of...Bachelor of Science in Nursing (BSN) or equivalent (with RN licensure) + 8+ years of clinical experience in… more
- Trinity Health (Columbus, OH)
- …information technology, financial analysis, audit, provider relations and more. **Position Purpose** RN Utilization Management MCHP is responsible for the ... the development of the Plan's UM Program and the review of the Plan's Utilization Management...Licensure / Certification: Current license to practice as a Registered Nurse in their home state or… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating ... benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer...+ Licensure in additional states a plus. + For registered nurses only: a bachelor's degree in (BSN) preferred.… more
- AmeriHealth Caritas (Washington, DC)
- …meet the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity...of 3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit… more
- AnMed Health (Anderson, SC)
- …, continued stay/concurrent review , retrospective review , bed status management , resource utilization management , regulatory compliance, and related ... issues. Duties & Responsibilities + Performs assigned utilization management functions daily: initial, concurrent and retrospective review of the… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact… more
- CVS Health (Harrisburg, PA)
- …in a hospital setting required for either BH or RN -1+ years of utilization review / utilization management required (ie concurrent review , ... to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and...they work (LMSW, LCSW, LISW, LPC, LMFT etc.) or Registered Nurse in state of residence -3+… more
- Actalent (Minnetonka, MN)
- Utilization Management Nurse Job...stays. Essential Skills + Expertise in utilization management and utilization review . + ... Description As a Utilization Management Nurse for Post Acute care, you will be responsible for reviewing and documenting prior authorization and concurrent… more
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