- Sharp HealthCare (San Diego, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... care and supports other members of the System Centralized Utilization Management team to ensure final status...clinical experience as defined by the CBA. + California Registered Nurse ( RN ) - CA… more
- Centene Corporation (Tallahassee, FL)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization … more
- Centene Corporation (Atlanta, GA)
- … management principles preferred. Prior authorization preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management (UM) functions for physical ... state and federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting… more
- Catholic Health Initiatives (Lexington, KY)
- …staff in support of the CommonSpirit Health Care Coordination model. The Utilization Management department processes authorizations, inpatient admission and ... our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director is...Joint Operating Committees. 5. Participates in the development and management of department budgets and productivity targets.… more
- CareFirst (Baltimore, MD)
- …location based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the ... utilization management team and is responsible for the design, assessment,...addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse -… more
- Point32Health (Canton, MA)
- …we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director , Utilization Management is responsible for directing, ... leadership. The Director oversees and leads medical management activities related to precertification utilization ..., Certification and Licensure** + Master's degree preferred. + RN ( Registered Nurse ) with unrestricted… more
- AmeriHealth Caritas (Dublin, OH)
- …+ Current and unrestricted RN license in OH. + 3+ years of utilization /case management experience in relevant scope preferred, one year required. + 3+ years ... ** Utilization Management Plan Oversight Manager** Location:...new and existing staff are oriented to organizational and department policies and procedures. Track that credential of all… more
- Crouse Hospital (Syracuse, NY)
- Utilization Management Registered Nurse has...proficient with standard Utilization Review processes. The Utilization Management RN is an ... workload in a fast-paced, rapidly changing regulatory environment. The Utilization Management RN works collaboratively.../ LICENSURE + Required: + Currently licensed as a Registered Professional Nurse in New York State.… more
- CVS Health (High Point, NC)
- …is part of the dedicated team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant...times may vary occasionally per the need of the department .** **-There is a late shift requirement until 9:00pm… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department : Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is...player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- CVS Health (Albany, NY)
- …role is 100% remote and the candidate can live in any state. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, ... care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant...**Required Qualifications** - Must have active current and unrestricted RN licensure in state of residence - 3+ years… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- Hackensack Meridian Health (Holmdel, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to.... **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- Hackensack Meridian Health (Hackensack, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to...**Licenses and Certifications Required** : + NJ State Professional Registered Nurse License. + AHA Basic Health… more
- Hackensack Meridian Health (Hackensack, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The Case Management Care Coordinator, Utilization Management is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to... Licenses and Certifications Required: + NJ State Professional Registered Nurse License + AHA Basic Health… more
- CVS Health (Atlanta, GA)
- …operation and work schedule may include weekends, holidays and evening hours. As a Utilization Management Nurse Consultant, you will utilize clinical skills ... **Required Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current...clinical experience in acute or post acute setting + Utilization management is a 24/7 operation. Work… more
- CVS Health (Springfield, IL)
- …operation and work schedule may include weekends, holidays and evening hours. As a Utilization Management Nurse Consultant, you will utilize clinical skills ... to coordinate, document and communicate all aspects of the utilization /benefit management program. - Utilizes clinical skills to coordinate, document and… more
- CVS Health (Tallahassee, FL)
- …may include weekends and holidays and evening rotations. This is a full-time remote Utilization Management Nurse Consultant opportunity. As a Utilization ... health care more personal, convenient and affordable. **Position Summary** Utilization management is a 24/7 operation. Work...of residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical… more
- Humana (Madison, WI)
- …decisions + Support the daily management and operations of the department . Oversees utilization management functions which include timely authorizations ... community and help us put health first** The Manager, Utilization Management Nursing utilizes clinical nursing skills...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in IL,… more