- Prisma Health (Greenville, SC)
- …and utilization of unit resources. Shares accountability with Nurse Manager for unit/department/organizational goal achievement.Assists in planning, ... health. Serve with compassion. Be the difference.Job SummaryIn collaboration with the nurse manager , supervises staff and unit operations and provides direct… more
- Prisma Health (Columbia, SC)
- …(TJC, DHEC, CMS). Provides care within the scope of the South Carolina Nurse Practice Act.The acute inpatient setting usually requires staff to be scheduled for ... clarify ideas-implementing and evaluating teaching plan (encourages patient/family involvement/participation)-Micromedex utilization -Computer resourcesCommunicates the patient/family's need for education/teaching to others… more
- LifePoint Health (Danville, VA)
- *Registered Nurse , RN - Utilization Review Case Manager * Job Type:Full Time|Days *$10,000 Sign-on Bonus Eligibility for Full-Time, Bedside RNs* ** Must have ... as an employee, but as a person. As a*registered nurse (RN)*joining our team, you're embracing a vital mission...offering safe discharge planning is the use of a Utilization RN and Case Manager RN, in… more
- Lowe's (Charlotte, NC)
- …years of experience in a clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Experience in ... license in home State + CCM - Certified Case Manager + CRRN - Certified Rehabilitation Registered Nurse... Manager + CRRN - Certified Rehabilitation Registered Nurse + CDMS - Certified Disability Management Specialist +… more
- Travelers Insurance Company (Buffalo, NY)
- …Imagine loving what you do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual base salary range ... Is the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective,… more
- Pipeline Health System, LLC (Toast, NC)
- Job Title: Utilization Review Registered Nurse - Behavioral Health Unit/FT/Days Job Summary: This Utilization Review (UR) Registered Nurse (RN) position ... and compassionate care to our patients. This position is responsible for utilization review, assessment of discharge planning needs and coordination of effective… more
- Elevance Health (Louisville, KY)
- ** Utilization Management Nurse (RN)** **$3,000 SIGN ON BONUS OFFERED** **Location** : Remote opportunity. Must reside in the state of Kentucky. The ** ... Utilization Management Nurse (RN)** is responsible to...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Tampa, FL)
- RN Utilization Management Nurse Sr. (Medicaid-InPatient) JR130851 **Location:** Must be within 50 miles / 1 hour commute of Tampa or Miami, FL offices. This is ... 4/10 hour shifts to include a weekend day. The ** Nurse Medical Management Sr** serves as T **eam Lead**...Requires minimum of 5 years acute care clinical experience, utilization management or managed care experience; or any combination… more
- US Tech Solutions (Columbia, SC)
- …Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates ... education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate… more
- Elevance Health (Washington, DC)
- The Utilization Management Nurse is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member ... minimum of 2 years acute care clinical experience. + Minimum 1 year Utilization Management experience preferred. For candidates working in person or remotely in the… more
- TEKsystems (Austin, TX)
- Job Summary + The Medical Records Utilization Case Manager will support documentation of medical necessity by facilitating medical records (MR) collection and ... client outreach, by offering expert review and interpretation on a case by case basis, and by maintaining collaborative and productive relationships within the organization relating to Revenue Cycle Management. Job Responsibilities: + Successfully obtain… more
- 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
- Sharp HealthCare (San Diego, CA)
- …Degree in Nursing; Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered ... utilization review, care coordination experience + California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED...Qualifications** + Master's Degree in Nursing + Certified Case Manager (CCM) - Commission for Case Manager … more
- VNS Health (Manhattan, NY)
- OverviewManages the utilization management team to ensure that standards for service delivery and team/staff performance levels are met or exceeded. This includes ... the VNS Health Plans teams on a day- to-day basis for utilization issues, problem resolution, complaint resolution and other service related issues. Manages… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- UNC Health Care (Hendersonville, NC)
- **Description** Job Summary The Utilization Manager (UM) assesses new admissions, continued stay and discharge review cases for medical necessity, appropriate ... met and care delivery is coordinated. The UM completes utilization reviews in accordance with federal regulations and the...patient data and treatments. Communicates daily with the Care Manager to manage level of care transitions & appropriate… 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...patient data and treatments. Communicates daily with the Care Manager to manage level of care transitions & appropriate… more
- Providence (Mission Hills, CA)
- **Description** The Manager of Utilization Management provides a key role in leading, facilitating and managing the hospital utilization management program ... in the Southern California Region. The Manager assists the Regional Director of Utilization ...or other related area + Upon hire: California Registered Nurse License + 5 years Healthcare management experience related… more
- Commonwealth Care Alliance (Boston, MA)
- …services,procedures, and facilities under the provisions of CCA's benefits plan.The Manager , Utilization Management is responsible for overseeing and managing ... the daily operation of the Utilization Management Review Nurse and Specialist staff...in the area of service decisions and organizational determinations.The Manager , Utilization Management reports to the Director… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Manager Care Mgt & Util Review **Employment Type:** Full Time **Shift:** Day ... to the Director of Care Management + The RN Manager is responsible and accountable for the operational management,...RN Case Managers for in inpatient care coordination and utilization review. Oversees interactions of staff with outside activities… more
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