- UNC Health Care (Raleigh, NC)
- **Description** **Full time exempt, 40 hours per week Utilization Manager - Medical necessity review for Surgical admissions** Become part of an inclusive ... care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… more
- UNC Health Care (Hendersonville, NC)
- …the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge review ... met and care delivery is coordinated. The UM completes utilization reviews in accordance with federal regulations and the...Required * Must be licensed to practice as a Registered Nurse in the state of North… more
- Independent Health (Buffalo, NY)
- …plan managed care operations required; multi-dimension project management experience preferred. + Registered Nurse ( RN ) with active, unrestricted NYS license ... perks, benefits and commitment to diversity and inclusion. **Overview** The Program Manager - Utilization Management (UM) will be accountable for the management,… more
- UCLA Health (Los Angeles, CA)
- …for assessing and coordinating care for a diverse group of patients. This in-patient utilization review case manager position will work on-site at our UCLA ... coordination of care. In this role you will perform utilization review while assuring the delivery of concurrent and...accepted for current UCLA Health Nursing staff) + CA RN License and BLS certification + Recent experience in… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... payors for additional clinical documentation. | Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as required.… more
- Covenant Health (Bangor, ME)
- …of the VP of Accountable Care Operations & Population Health Strategy the Utilization Review Case Manager will work collaboratively with other members of ... the healthcare team. The nurse case manager also acts as an... conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Manager of Utilization Review oversees a team of utilization review nurses and coordinators, ensuring compliance with clinical regulatory ... Manager to facilitate coordination of services related to utilization review. Collaborates with the multidisciplinary team, lending professional...+ 3-5 years work experience in healthcare as a nurse required + 1-3 years work experience in Care… more
- Beth Israel Lahey Health (Burlington, MA)
- …8:00am-4:30pm Weekend and holiday rotations required **Job Description:** The Inpatient Registered Nurse ( RN ) Case Manager for Hospital at Home Care ... a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse ...the needs of the department. **Minimum Qualifications:** Education: * Registered Nurse , Bachelors Degree or commensurate experience… more
- UPMC (Hanover, PA)
- …required with 4-6 weeks of hire. UPMC approved Care Management certification preferred. + Registered Nurse ( RN ) + Act 34 *Current licensure either in ... **UPMC is hiring a part time Professional Care Manager for our Utilization Review department...preferred. **Licensure, Certifications, and Clearances:** Current licensure as a Registered Professional Nurse either in the state… more
- McLaren Health Care (Detroit, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay ... Functions and Responsibilities as Assigned:** 1. Collaborates with the UM RN to determine the appropriate hospital setting (inpatient vs. observation) based… more
- Healthfirst (NY)
- …, LPN, LMSW, LMHC,LMFT, LCSW, PT, OT, and/or ST license + For Episodic Utilization /Case Management: NYS RN or Licensed Social Worker (LCSW/LMSW any state) ... Negotiates rates with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community resources to… more
- Fairview Health Services (St. Paul, MN)
- **Overview** **Fairview Health Services is hiring a casual** ** Utilization Management Spec RN ** **to join our Revenue Cycle Management team. This is a remote ... projects and assume other duties as assigned by the Utilization Review Manager or Supervisor. + Understand...years of acute care hospital nursing experience. + Current RN License **Preferred** + Minimum of 1-year Epic experience.… more
- Prime Healthcare (Weslaco, TX)
- …#hiringrns #registerednurse #casemanagement Connect With Us! (https://careers-primehealthcare.icims.com/jobs/188814/ registered - nurse -case- manager ... Qualifications Education and Work Experience Required qualifications: 1. BSW or other Bachelor ( RN ) degree in a related field. At least one year experience in case… more
- Ascension Health (Baltimore, MD)
- …education, experience, location, qualifications and comparison with associates in similar roles_ ** Registered Nurse , Certified Case Manager (CCM, ACM, URAC) ... **Details** + **Department:** Utilization Management + **Schedule:** On-site, Monday-Friday, 8:00AM-4:30PM. Must...of staff **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date… more
- Morris Hospital (Morris, IL)
- …and federal regulatory requirements and payer/reimbursement methodologies. + Licensure as Registered Nurse in Illinois. + DCFS Mandated Reporter Certificate ... evidenced-based clinical guidelines. Performs duties in accordance with the Utilization Review Plan. Demonstrates thorough knowledge of performance measure… more
- Prime Healthcare (Lynwood, CA)
- …experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 ... experience, education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/189323/case- manager utilization -review/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySt. Francis Medical Center… more
- Pacific Medical Centers (Renton, WA)
- …order to assure cost effective, appropriate utilization of health care resource. Utilization Nurse / Case Manager manages, directs, and coordinates the ... best people, we must empower them. **Required Qualifications:** + Upon hire: Washington Registered Nurse License. + 5 years Clinical experience. + Utilization… more
- UNC Health Care (Hendersonville, NC)
- …issues with complex patients and identify trends. Formulates potential solutions with Utilization Manager and Social Worker and continuously monitor cases/follow ... of the unique communities we serve. Summary: The Care Manager - RN provides ongoing support and...Required * Must be licensed to practice as a Registered Nurse in the state of North… more
- Sutter Health (Davis, CA)
- …patient experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside RN to assure the timely ... school of nursing + Bachelor's in Nursing preferred. **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** +… more
- Trinity Health (Philadelphia, PA)
- …day shift. **:** Under the general supervision of the Manager of Utilization Management, the Utilization RN assists physicians and the interdisciplinary ... a member of Trinity Health Mid-Atlantic, is seeking experienced Utilization Management RN to join the Case Management team! **Schedule:** Full-time, 40hrs/wk,… more
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