• Telephonic Nurse Case Manager I

    Elevance Health (Atlanta, GA)
    ** Telephonic Nurse Case Manager I - $3000 Sign-On Bonus Offered** **Location: This is a virtual position, but you must reside in the State of Georgia.** **Work** ... the assessment within 48 hours of receipt and meet the criteria._** The ** Telephonic Nurse Case Manager I** is responsible for telephonic care management… more
    Elevance Health (11/02/24)
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  • Telephonic Nurse Case Manager II

    Elevance Health (Costa Mesa, CA)
    ** Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... members in different states; therefore, Multi-State Licensure will be required.** The ** Telephonic Nurse Case Manager II** is responsible for care management within… more
    Elevance Health (11/02/24)
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  • Utilization Review RN - Per Diem

    Trinity Health (Fort Lauderdale, FL)
    **Employment Type:** Part time **Shift:** **Description:** The Utilization Review (UR) Nurse has well-developed knowledge and skills in areas of utilization ... requirements of various commercial and government payers. On-Site Position** **_Position Purpose:_** Utilization Review (UR) Nurses play a vital role in… more
    Trinity Health (10/12/24)
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  • Utilization Review Nurse

    US Tech Solutions (Columbia, SC)
    …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. + A typical day would like in this… more
    US Tech Solutions (10/31/24)
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  • Utilization Management RN (mostly remote)

    VNS Health (Manhattan, NY)
    …subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is ... general supervision. Compensation Range:$85,000.00 - $106,300.00 Annual * Conducts comprehensive review of all components related to requests for services which… more
    VNS Health (10/26/24)
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  • Integrated Care Coordinator

    Spokane County (Spokane, WA)
    …Organization Integrated Care and the Behavioral Health Administrative Services Organization Utilization Review Integrated Care. TOTAL COMPENSATION: $85,812 - ... and discharges or lack of movement toward discharge. + Collaborates with Utilization Review Integrated Care Coordinator regarding continued inpatient stay… more
    Spokane County (10/25/24)
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  • Registered Nurse- In Home Primary Care- Hybrid

    The Cigna Group (Philadelphia, PA)
    …works as part of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including social ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...to nursing team by clinical support staff. 2. Provide telephonic nursing assessment and triage supported by triage protocols.… more
    The Cigna Group (10/18/24)
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  • Registered Nurse Case Manager

    US Tech Solutions (Columbia, SC)
    …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4 ... + A typical day would like in this role: Employee will be providing telephonic case management for our members. + Past job instability. Registered nurses MUST have… more
    US Tech Solutions (10/18/24)
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  • Senior Medical Management Nurse - VCHCP

    Ventura County (Ventura, CA)
    …Duties may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent, retrospective, out of network and ... experience in Case Management, Disease Management, Quality Assurance, HEDIS and/or Utilization Review . NECESSARY SPECIAL REQUIREMENTS + Must possess and… more
    Ventura County (10/24/24)
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  • Clinical Operations Supervisor - RN

    Kepro (Chicago, IL)
    …Supervising and managing the day-to-day activities of the assigned case management and utilization review teams. + Mentoring, coaching, and training team members ... Supervises, mentors, coaches, trains, and develops the: o Case review and utilization review teams...(CCM). + Analytical, reporting, and data management skills. + Telephonic case management and/or triage experience. + Knowledge of… more
    Kepro (08/15/24)
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  • Senior Care Coordinator

    Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
    …Management services to its clients. Care Coordinators facilitate care management and utilization review by performing data collection, data entry, and ... The Senior Care Coordinator reports to the Senior Nurse Manager, Utilization Management. Primary Responsibilities + Partner with leadership in cross training… more
    Brighton Health Plan Solutions, LLC (10/22/24)
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  • Physician Advisor

    Mohawk Valley Health System (Utica, NY)
    …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives,… more
    Mohawk Valley Health System (09/18/24)
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  • Medical Director

    Highmark Health (Columbus, OH)
    …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The… more
    Highmark Health (10/23/24)
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  • Physician Advisor Denials Management

    CommonSpirit Health (Sacramento, CA)
    …community. **Responsibilities** **This is a remote position.** **Summary** The Utilization Management Physician Advisor II conducts clinical case reviews referred ... with the hospital's objectives for assuring quality patient care and effective and efficient utilization of health care services. This position will be a part of the… more
    CommonSpirit Health (09/20/24)
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  • Case Manager RN - Remote

    Actalent (Santa Barbara, CA)
    …the HPNC may perform utilization management activities, which may include telephonic or onsite clinical review ; case or disease management, care coordination ... Nurse Coordinator Non-profit healthcare network is looking for a utilization management registered nurse to join their team on...to work a 3-month contract + Medi-Cal Experience + Utilization Management WHAT'S IN IT FOR YOU: + Remote… more
    Actalent (11/02/24)
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  • Clinical Case Manager Behavioral Health - Detroit…

    CVS Health (Lansing, MI)
    …Monday - Friday, 8:00 am - 5:00 pm EST. This role is a telephonic clinical case management position working with our Medicaid population. Use of Motivational ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Assessment of… more
    CVS Health (11/01/24)
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  • Remote Nurse Coach

    Actalent (Tampa, FL)
    …to established healthcare goals and care plans. + Use clinical expertise to review utilization information concerning patient care and match those needs to ... an acute care setting to the home setting through telephonic outreach. You will provide education, coaching, and care...Essential Skills + Health care + Managed care + Utilization management + Telehealth + Care management + Disease… more
    Actalent (10/30/24)
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  • Coordinator, Managed Care I

    ManpowerGroup (Columbia, SC)
    …of clinical experience. + **Preferred:** 7 years in healthcare program management, utilization review , or clinical experience in specialties such as oncology, ... to join one of our Fortune 500 clients. **Job Summary** The Clinical Review Specialist assesses and evaluates medical or behavioral eligibility for health benefits,… more
    ManpowerGroup (10/30/24)
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  • Managed Care Coordinator UM II

    ManpowerGroup (Columbia, SC)
    …health, chronic or acute illnesses. **Key Responsibilities** + **Medical or Behavioral Review & Authorization Process (50%)** + Perform review and authorization ... within benefit and medical necessity guidelines. + Utilize resources to support review determinations. + Identify and make referrals to appropriate staff (eg,… more
    ManpowerGroup (10/30/24)
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  • Nurse Care Manager

    Spectrum Health Services (Philadelphia, PA)
    …health and/or psychosocial problems through practice and home-based visits and telephonic support on a care management or case management basis appropriate ... team, assesses patients for risk of adverse health outcomes, inappropriate utilization , and monitors the impact of care management interventions. Essential… more
    Spectrum Health Services (09/19/24)
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