- Humana (Phoenix, AZ)
- **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing utilizes clinical nursing skills ... documentation and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works… more
- Commonwealth Care Alliance (Boston, MA)
- …care 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...in the area of service decisions and organizational determinations.The Manager , Utilization Management reports to… more
- AdventHealth (Altamonte Springs, FL)
- …Remote **The role you'll contribute:** The Divisional Manager of Utilization Management (UM) is a registered nurse , who works under the direction of the ... direction setting, management , continuous improvement, and maintenance Utilization Management team. The Divisional Manager...addition to RN licensure) . Bachelor of Science in Nursing - or other related BS or BA in… more
- HCA Healthcare (Richmond, VA)
- …and integrity. We care like family! Jump-start your career as a(an) Case Manager Behavioral Utilization Management today with Chippenham Hospital. ... by location._** Come join our team as a(an) Case Manager Behavioral Utilization Management . We...of employment start date + Bachelors Degree, or Registered Nurse Diploma + Licensed Clinical Social Worker (LCSW), or… more
- CVS Health (Springfield, IL)
- …**Position Summary:** The Associate Manager is responsible for oversight of Utilization Management /Case Management staff. This position is responsible ... Nurse + 3+ years of Managed Care experience + 1+ years of Utilization Management experience + 1+ year Leadership experience (formal or informal roles) +… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review, under the supervision and in collaboration with ... applicable):** + State of Maryland license as a Registered Nurse + RN with BSN or RN with >...area. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + Knowledge of… more
- UCLA Health (Los Angeles, CA)
- …the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management ... RN licensure in CA required + Bachelors of Science, Nursing (BSN) degree required + Five or more years...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- VNS Health (Manhattan, NY)
- …experience in management for a health plan or utilization /case management Required Master's Degree in Nursing or Health Care Administration Preferred ... OverviewManages the utilization management team to ensure that...and current registration to practice as a registered professional nurse in New York State Required Valid driver's license… more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Manager , Utilization Management Behavioral Health utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Behavioral Health works within… more
- UNC Health Care (Smithfield, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection...and obtains observation status as appropriate. Partners with physicians, nursing , and other care providers to help ensure timely… more
- Trinity Health (Silver Spring, MD)
- …acute healthcare setting required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At least 5-7 years ... - 4:30pm + Reporting to the Director of Care Management + The RN Manager is responsible...status and insurance. **Responsibilities:** + Works collaboratively with the Nursing Director and Sr. Director of Care Management… more
- BronxCare Health System (Bronx, NY)
- …and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients, ... includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. Under the direction of the Utilization Management , Assistant Manager , you will play a key role in processing ... reports and manage computer applications and logs + Monitor members/patients followed by Case Management + Work directly with a nurse team lead + Review pending… more
- Sharp HealthCare (San Diego, CA)
- …System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center ... Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing...Experience and understanding of federal and state regulations governing utilization management . + Accredited Case Manager… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …prospective, and concurrent reviews. The Senior Care Coordinator reports to the Senior Nurse Manager , Utilization Management . Primary Responsibilities + ... About The Role Brighton Health Plan Solutions provides Utilization Management services to its clients....performing data collection, data entry, and effectively communicating with Nurse reviewers and leaders' employers and claimants in regard… more
- CVS Health (Carson City, NV)
- …experience working in a high volume clinical call center environment + 1+ year Utilization Management experience + 1+ years Managed Care experience + Remote work ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Utilizes clinical experience and skills in… 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 ... Friday. **2 Holidays** per year and **occasional** weekends. The ** Nurse Medical Management Sr** serves as T...Requires minimum of 5 years acute care clinical experience, utilization management or managed care experience; or… 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...Utilization Management Nurse (RN)** is responsible to collaborate...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Children's Hospital Boston (Boston, MA)
- …Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Office/Site Location:BostonRegular, Temporary, Per Diem:Per Diem ... 74825BRJob Posting Title:RN Case Manager , Inpatient & Ambulatory (Per Diem)Department:Patient Services-Patient Care… more
- Guthrie (Sayre, PA)
- …timely, coordinated, and cost- effective manner. The Manager -of Case Management supports utilization management , discharge planning, denial prevention, ... right time. + Manages and assumes responsibility for day-to-day operations of utilization management , care coordination, and discharge planning activities. +… more