- AnMed Health (Anderson, SC)
- …continued stay/concurrent review, retrospective review, bed status management , resource utilization management , regulatory compliance , and related denial ... is responsible for performing the daily operations of the Utilization Management program at AnMed within the...of severity of illness and intensity of services, regulatory compliance with documentation and physician orders. + Reviews all… more
- CVS Health (Baton Rouge, LA)
- …And we do it all with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for NICU Concurrent Review conducts ... NICU clinical expertise * Family-centered care and advocacy * Utilization management and regulatory compliance ...detail and data integrity **Required Qualifications** * Active, unrestricted RN license in Louisiana or a compact license. *… more
- UNC Health Care (Kinston, NC)
- …clinical experience as a Registered Nurse required. + 2 years utilization review, care management , or compliance experience preferred. + Minimum 1 ... management preferred. + **LICENSURE/REGISTRATION/CERTIFICATION** + Licensed to practice as a Registered Nurse in the state of North Carolina. **Job Details**… more
- Intermountain Health (Las Vegas, NV)
- …services, including social work and complex care planning, transitions of care, and utilization management . The position ensures compliance with state, ... + Continuous Improvement + Scheduling **Physical Requirements:** **Minimum Qualifications** + Current Registered Nurse ( RN ) license in state of practice… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …colors to blue. The Role:The Compliance Program Consultant will focus on utilization management compliance and audit readiness activities such as ... Management 's (HMM) and delegate's compliance with the applicable NCQA utilization management standards and state and federal regulations. The Team: This… more
- Centene Corporation (New York, NY)
- … (UM) to align to goals and objectives + Develops, implements, and maintains compliance with utilization management policies and procedures + Reviews ... years supervisory experience preferred. Knowledge of utilization management principles preferred. **Applicants must possess NY RN...am - 5:00 pm with holiday rotation.** **License/Certification:** + RN - Registered Nurse -… more
- Community Health Systems (Franklin, TN)
- …evaluating the necessity, appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts ... extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key...regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse -… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse I Department: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time) Schedule: ... Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act...Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse -… 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 ... Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE...full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate… more
- Humana (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cedars-Sinai (Los Angeles, CA)
- …one of America's Best Hospitals. Summary of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent ... Eye/Hand/Foot Coordination **Req ID** : 14355 **Working Title** : Registered Nurse - Utilization Review Case...Review Case Manager - 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical… more
- Actalent (Atlanta, GA)
- …weekends) About the Role We are seeking a detail-oriented and compassionate Utilization Review Registered Nurse ( RN ) to join our team. In this role, you ... Job Title: Utilization Review RN Location: Buckhead, GA...providers, members, and internal teams (claims, benefits, appeals, risk management ). Required Qualifications + Active RN license… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse ( RN ) -...Management and Compliance policies, InterQual, Transition Management , Utilization Management , and other ... dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the...for case management scope of services including: Utilization Management supporting medical necessity and denial… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse ( RN ) - Nursing Admin - 2506002696 Description : DMC Detroit Receiving Hospital , Michigan's first Level I Trauma Center, helped pioneer the ... DMC Rosa Parks Geriatric Center of Excellence. SUMMARY The Registered Nurse ( RN ) is a...prepares patient for discharge, utilizing established clinical pathways. The RN reports directly to senior unit management ,… more
- Penn Medicine (Lancaster, PA)
- …placement in position for incumbents who started after 07/01/2020. + A graduate registered nurse may only practice professional nursing under supervision and if ... the graduate registered nurse holds a current temporary practice... nurse is practicing. + All Clinical Nurse 1 RN 's will be required to… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse ( RN ) - Med SurgDepartment: Med / Surg (2 South)Location: Newark Wayne Community HospitalHours Per Week: Part Time (24 ... hours)Schedule: Evening/Night (6pm-6:30am), rotating weekends and holidays SUMMARY:As a Registered Nurse ( RN ), you're the engine and the heart of patient… more
- Bon Secours Mercy Health (Portsmouth, VA)
- …are recognized for clinical and operational excellence. ** Registered Nurse ( RN ) - Manager of Case Management - Maryview Medical Center** **$10,000 ... standards for care management scope of service: Education, Care Coordination, Compliance , Transition Management and Resource Utilization . + Utilizes… more
- Ochsner Health (New Orleans, LA)
- …discharge plans based on patient's individualized needs. Registered Nurse ( RN ) Case Manager - Case Management OMC Jefferson Highway PRN To perform ... experience in discharge planning, case management or utilization review. **Certifications** Required - Current registered ...or utilization review. **Certifications** Required - Current registered nurse license in state of practice.… more
- Trinity Health (Silvis, IL)
- …As One! (http://www.genesishealth.com/) Join the MercyOne Family! We are looking to hire a Registered Nurse ! A dedicated Charge Nurse is a registered ... plan, projected volumes, patient/acuity and other relevant indicators. Assures compliance with staffing plan. + Oversees daily operations, staff...+ Bachelor of Science in Nursing (BSN) preferred + Registered Nurse in Illinois, Registered … more
- Avera (Scotland, SD)
- …join our team! We offer quality care close to home. **Position Highlights** **Seeking a Registered Nurse ( RN ) to join our team at Landmann-Jungman Memorial ... professional level of behavior in her/his role as an RN . The American Nurses Associations (ANA) scope and standards...**CERTIFICATION, LICENSURE, and/or REGISTRATIONS:** + Current licensure as a Registered Nurse in the State of South… more
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