- SSM Health (St. Charles, MO)
- …regarding opportunities for improvement in standard work. May also be responsible for: utilization management process, ED case management process, admission ... case manager liaison with post acute providers (skilled nursing facilities, rehab, home health, etc.). Applies the existing body of evidence-based practice and… more
- Memorial Hermann Health System (Humble, TX)
- …and when appropriate or requested when the hospitalist service is in the co- management or consultative role. Cover Code Blue and Rapid Responses in accordance with ... with the hospital on call schedule and patient assignment guidelines. Provide co- management services for subspecialty services when such services are within the… more
- Hartford HealthCare (Willimantic, CT)
- …**Title:** *Registered Nurse Case Manager (RN) - Utilization Management * **Location:** *Connecticut-Willimantic-Windham Community Memorial (10183)* ... nursing required. * Two years experience with case management , discharge planning, utilization review and/or home care required. * Knowledge of the … more
- CVS Health (Austin, TX)
- …more compassionate. And we do it all with heart, each and every day. Utilization Management - Infertility Precertification unit **Position Summary** This is a ... Work at Home role. Working hours are Mon-Fri 8-5pm in your...experience with Microsoft Office applications (Outlook, Teams, Excel) + Utilization Management is a 24/7 operation and… more
- Sanford Health (Rapid City, SD)
- …providing direct supervision of all departmental staff. Maintains a standardization of utilization management process to ensure all policies and procedures are ... Full time **Weekly Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management Manager and lead a high-impact, data-driven… more
- Integra Partners (Troy, MI)
- …experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key ... UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse 's responsibilities include but are not limited to: + Perform… more
- CenterWell (Austin, TX)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous...Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. + Bilingual We offer tangible and intangible… more
- US Tech Solutions (Columbia, SC)
- …established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to ... education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through… more
- Albany Medical Center (Albany, NY)
- …clinical experience in an assigned service.* Recent experience in case management , utilization management and/or discharge planning/ home care in a high ... Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for… more
- Truman Medical Centers (Kansas City, MO)
- …time **Work Schedule** 7:30AM - 4:00PM **Hours Per Week** 40 **Job Description** The Utilization Management Nurse (UM RN) collaborates with members of the ... into myWORKDAY (http://www.myworkday.com/trumed/d/ home .htmld) to search for positions and apply.** Utilization Mgmt Nurse RN - Care Continuity - UH Truman… more
- Sanford Health (Rapid City, SD)
- …community. **Job Summary** Provides expertise and leadership to ensure effective resource management for patient care delivery across the care continuum for assigned ... patient wellness through evidenced based practice, improved care outcomes, efficient utilization of health services, and appropriate level of care for patients… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention ... potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements and… more
- Humana (Jackson, MS)
- **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
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong...3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit (ICU), Emergency Department… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... expected to work a portion of their week from home and a portion of their week at a...business. **Knowledge, Skills and Abilities (KSAs)** + Oversight of Utilization Management clinicians while championing process improvement,… more
- CVS Health (Baton Rouge, LA)
- …it all with heart, each and every day. **Position Summary** The Utilization Management Coordinator/UMNC assists in ensuring that authorization request decisions ... children, ie generators, housing, rentals) * Collaborate with care management and utilization management teams...in joint planning sessions with enrollees' school, providers and home health agencies, as needed * Coordinate with care… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... To provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal management and development… more
- Providence (Mission Hills, CA)
- …strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, and patient status determination. The ... Utilization Management RN must effectively and efficiently manage a diverse...Qualifications:** + Associate's Degree in Nursing. + California Registered Nurse License upon hire. + 2 years of experience… more
- Sharp HealthCare (San Diego, CA)
- …1 **Shift Start Time** **Shift End Time** Other; California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours** ... + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program. + California Licensed Vocational Nurse...1 Year experience in the acute patient care, SNF, home health, or hospice settings. + Experience as a… more
- BayCare Health System (Tampa, FL)
- …Occasional + **On Call:** No **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management ) + Preferred CCM (Case Manager) ... of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians.... Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse… more
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