• Utilization Management Nurse

    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
    LA Care Health Plan (02/01/25)
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  • System Utilization Management

    Alameda Health System (Oakland, CA)
    System Utilization Management Specialist +...staff. 8. Per the direction and delegation of the Utilization Management social worker and/or nurse ... Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Care Management + Req #:40890-30208 + FTE:1 + Posted:December 30,… more
    Alameda Health System (01/23/25)
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  • Utilization Management

    Penn State Health (Hershey, PA)
    …status, and family medical or genetic information._ **Union:** SEIU Healthcare Pennsylvania **Position** Utilization Management Specialist - DAY SHIFT - ... for maintaining compliance with the CMS Conditions of Participation for Utilization Management . **MINIMUM QUALIFICATIONS:** + Bachelors Degree in Nursing… more
    Penn State Health (01/01/25)
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  • PRN Utilization Review Clinical…

    Community Health Systems (Franklin, TN)
    …clinics, imaging centers, cancer centers and ambulatory surgery centers. **Summary:** Utilization management is the analysis of the necessity, appropriateness, ... to be gathered from the physician presenting after the call and documented in the case management system by the UR Review Specialist . + In the event a facility… more
    Community Health Systems (01/19/25)
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  • Utilization Management

    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
    Vanderbilt University Medical Center (01/29/25)
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  • Utilization And Appeal Specialist

    Beth Israel Lahey Health (Milton, MA)
    …and Responsibilities: 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate ... payer certification, and denied cases. 5. Monitors effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics,… more
    Beth Israel Lahey Health (01/29/25)
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  • Utilization Review Specialist - PRN

    Munson Healthcare (Traverse City, MI)
    …of resources. + Assists in developing and revising policies to support utilization management activities, including criteria and guidelines for appropriate use ... colleagues and hospital associates at information meetings. + May represent Utilization Management on various committees, professional organizations, physician… more
    Munson Healthcare (11/09/24)
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  • Regional Utilization Review Documentation…

    Trinity Health (Maywood, IL)
    …is Loyola campus. Position is hybrid, must reside in Illinois. The **Regional Utilization Review Documentation Specialist ** nurse works with the ... in collaboration with attending physicians. + Actively participates in the Utilization Management committee. + Additional responsibilities as needed. **We… more
    Trinity Health (02/01/25)
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  • RN Utilization Review Specialist

    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
    HonorHealth (01/29/25)
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  • Utilization Management Nurse

    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
    Katmai (01/18/25)
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  • Clinical Nurse Educator III,…

    Sutter Health (Sacramento, CA)
    …& LICENSURE:** + RN-Registered Nurse of California OR CNS-Clinical Nurse Specialist + BLS-Basic Life Support Healthcare Provider OR ACLS-Advanced ... internally and externally, including clinical and support staff, other departments, management , Sutter Health clinical nurse educators, college staff, regional… more
    Sutter Health (12/31/24)
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  • Registered Nurse (Quality Management

    Veterans Affairs, Veterans Health Administration (Leeds, MA)
    Summary This Registered Nurse (Quality Management Accreditation Specialist ) position is located in the Quality and Patient Safety Services at the Leeds, MA ... utilization , and evaluation of the facilities programs in risk management , clinical analysis, patient safety, utilization with a primary focus… more
    Veterans Affairs, Veterans Health Administration (01/31/25)
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  • Denials Management Specialist , Full…

    St. Luke's University Health Network (Allentown, PA)
    …serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical ... hospital setting required. Prefer minimum of 2-5 years' experience in case management and/or utilization management required. Prefer financial experience… more
    St. Luke's University Health Network (12/28/24)
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  • Registered Nurse Specialist -F/C

    MyFlorida (Gainesville, FL)
    REGISTERED NURSE SPECIALIST -F/C - 60032928 Date: Jan 11, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... . Requisition No: 843066 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST -F/C - 60032928 Pay Plan: Career Service Position Number:… more
    MyFlorida (12/21/24)
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  • Clinical Payment Resolution Specialist -I…

    Trinity Health (Farmington Hills, MI)
    …regulations, healthcare financing and managed care. Knowledge of and experience in case management and utilization management . Knowledge of insurance and ... rejection, denial and appeal activities with Ministry Organization (MO) based Utilization Review/Case Management departments; + Reviews and understands … more
    Trinity Health (01/30/25)
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  • Registered Nurse Specialist - F/C…

    MyFlorida (Chattahoochee, FL)
    REGISTERED NURSE SPECIALIST - F/C - 67056731...dynamics. This position with APD will serve staff and management across the Agency. Your work will impact the ... . Requisition No: 837602 Agency: Agency for Persons with Disabilities Working Title: REGISTERED NURSE SPECIALIST - F/C - 67056731 APD/ DDDP CHATTAHOOCHEE, FL Pay… more
    MyFlorida (01/30/25)
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  • Registered Nurse Specialist -F/C Ops

    MyFlorida (Gainesville, FL)
    REGISTERED NURSE SPECIALIST -F/C OPS - 60957257 Date: Jan 28, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... . Requisition No: 843860 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST -F/C OPS - 60957257 Pay Plan: Temp Position Number:… more
    MyFlorida (01/01/25)
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  • Referral Specialist Registered Nurse

    Sanford Health (Sioux Falls, SD)
    …Accreditation (NLN CNEA). Will consider applicant with significant background in case management and/or utilization management experience. Minimum of three ... utilization and potentially, prior authorization. Assists the department in monitoring the utilization of resources, risk management and quality of care for… more
    Sanford Health (01/14/25)
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  • RN Recovery Nurse Specialist

    Ochsner Health (New Orleans, LA)
    …Louisiana Registered Nurse (RN) License Preferred - Certification in Case Management (CCM) or Certified Professional in Utilization Review, Utilization ... to all medical necessity audits. **Education** Required - Registered Nurse Diploma Preferred - Associate's or Bachelor's degree in...of patient care as an RN. Experience in Case Management , Utilization Review and/or Discharge Planning .either… more
    Ochsner Health (01/29/25)
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  • Nurse Practitioner - Clinical…

    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
    Cambridge Health Alliance (12/04/24)
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