- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... Practical Nurse - State Licensure Upon Hire Required + CNS-Clinical Nurse Specialist Preferred **Experience:** + 5 years Clinical nursing experience. +… more
- Vanderbilt University Medical Center (Nashville, TN)
- …through preeminent programs in patient care, education, and research. **Organization:** Utilization Management 20 **Job Summary:** JOB SUMMARY Facilitates ... appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review when… more
- Sanford Health (Sioux Falls, SD)
- …Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to ... utilization and potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality of care for… more
- BayCare Health System (St. Petersburg, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... every 3rd + **On Call:** No **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management ) + Preferred CCM (Case Manager)… more
- System One (Baltimore, MD)
- ALTA IT Services is staffing a contract to hire opportunity for a Utilization Management Specialist to support a leading health insurance customer. The ... Req LPN - Licensed Practical Nurse - State Licensure CNS-Clinical Nurse Specialist Duties: + Determines medical necessity and appropriateness by referencing… more
- HonorHealth (Scottsdale, AZ)
- …communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... in an acute care setting. Required 1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse (RN) State And/Or Compact… more
- Katmai (Usaf Academy, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... licensed in Colorado, be able to practice using a nurse compact state license or have a license from...checks. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional… more
- UCLA Health (Los Angeles, CA)
- Description The Quality Management Nurse Specialist serves as the key resource for the investigation of member complaints, grievances, quality of care and ... data collection, data input and report development. The QM Nurse Specialist will adhere to NCQA, State,...experience required + Minimum three years of experience in Utilization Management or Quality Management … more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- BCDPHA Nurse Consultation Specialist Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4824327) BCDPHA Nurse Consultation Specialist ... + Description + Benefits Supplemental Information Please clickHERE (https://ulsuno.wd1.myworkdayjobs.com/en-US/UniversityOfNewOrleans/job/Baton-Rouge-La/BCDPHA- Nurse -Consultation- Specialist \_R-001512?q=R-001512) to apply + Provides professional… more
- MyFlorida (Gainesville, FL)
- REGISTERED NURSE SPECIALIST -F/C - 60005472 Date: Mar 8, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... Requisition No: 797758 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST -F/C - 60005472 Position Number: 60005472 Salary:… more
- MyFlorida (Chattahoochee, FL)
- REGISTERED NURSE SPECIALIST - 60006454 Date: Mar 8, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... No: 843100 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST - 60006454 Pay Plan: Career...Ability to analyze complex reports and determine the service utilization habits of clients and to evaluate the appropriateness… more
- Rush University Medical Center (Chicago, IL)
- …an integrated role of practice, education, administration and research. The Clinical Nurse Specialist exemplifies the Rush mission, vision, and values and ... disability, veteran status, and other legally protected characteristics. **Position** Clinical Nurse Specialist , Neuro IMCU **Location** US:IL:Chicago **Req ID**… more
- Banner Health (Mesa, AZ)
- …If you're looking to leverage your abilities - apply today. **As a Registered Nurse Support Operations Specialist , you will provide support for the PAT and ... Our Endoscopy Unit maintains 6 procedural rooms, along with utilization of the OR, as needed. Nursing careers are...when applicable** **.** If you are a New Graduate Nurse with less than 12 months of experience, please… more
- Cambridge Health Alliance (Cambridge, MA)
- Nurse Practitioner - Clinical Specialist II (APRN), Psychiatry **Date Posted:** 09/24/2024 **Requisition Number:** CHAP-2270 **Cambridge Health Alliance (CHA)** ... is required authorizing practice in an expanded role as a Psychiatric Nurse Clinical Specialist and authorization including prescriptive authority. _In keeping… more
- Bon Secours Mercy Health (Richmond, VA)
- …Masters degree from an accredited school of Nursing. + Currently registered as a Clinical Nurse Specialist , licensed as a Nurse Practitioner or eligible to ... excellence. Job Description **Primary Function/General Purpose of Position** The Advanced Practice Nurse (APN) at St. Mary's Hospital is a professional nurse … more
- Sanford Health (SD)
- …- $28.00 **Department Details** Opportunity to work remote. **Job Summary** Monitors the utilization of resources, risk management and quality of care for ... multiple administrative duties including accurate record keeping and electronic data management when needed. Ability to work with growth and development needs… more
- AdventHealth (Maitland, FL)
- …**Location** : Maitland, FL **The role you'll contribute:** **The Care Transitions Registered Nurse ensures that a care plan is carried out in partnership with the ... various other teams, including but not limited to Care Management nurses and social workers, nursing, home care liaisons,...high risk for readmission or for high emergency room utilization . Follows up with patients at location of post… more
- BayCare Health System (Clearwater, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... necessity of outpatient observation and inpatient stays and the utilization of ancillary services + Perform other duties as...Call:** No **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management ) +… more
- Hospice of Michigan (Ann Arbor, MI)
- …hospice & palliative care quality reporting, patient care, safety, risk management , infection control, outcomes and customer satisfaction. + Works collaboratively ... of Service: courtesy, acknowledgement, response and empathy. Qualifications: + Registered Nurse with a baccalaureate degree in nursing, preferably a Master's Degree… more
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