- University of Maryland Medical System (Largo, MD)
- … manager to maintain employee/supervisor relationships, and also assists in balancing time management for nurse manager . Assistant Manager is on-point ... Capital Region Health - Largo, MD Reporting to a Nursing Director- or other senior clinical leader, the Assistant... management .Under the direction and supervision of the Nurse Manager ., develops and implements effective human… more
- University of Maryland Medical System (Baltimore, MD)
- …conditions, and infectious diseases. Job Description Under general administrative direction of the Clinical Nurse Manager , the Assistant Nurse Manager is ... continuity of services while working in coordination with Clinical Nurse Manager . The Assistant Nurse ...nursing , is required. Education: BSN (Bachelor's Science of Nursing ) required. Masters' degree with management coursework… more
- University of Maryland Medical System (Bel Air, MD)
- …preferred. Work Orientation & Experience: Three to five years' experience in Case Management and understanding of Utilization Management . Acute care ... Bel Air, MD The Senator Bob Hooper House, Forest Hill, MD Job Description Manager of Case Management Full-time, Days, 8am-5:30pm JOB SUMMARY: Supervises team… more
- University of Maryland Medical System (Baltimore, MD)
- …patients within an assigned case load for care coordination, discharge planning, and utilization management services Facilitates early referral to high risk case ... management care plans. Qualifications Licensure as a Registered Nurse (RN) in the state of Maryland, or eligibility...management and knowledge of payer mechanisms and clinical utilization management is preferred. Two years experience… more
- Humana (Madison, WI)
- **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing utilizes clinical nursing skills ... medical services and/or benefit administration of post-acute determinations. The Manager , Utilization Management Nursing...to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in IL, WI, MN, SD, ND, IA,… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** **Description:** The Manager -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
- Molina Healthcare (NV)
- …not a compact state at this time.** **Prior experience with managed care (Medicaid, Medicare) Utilization Management processes and 3 + years in management / ... performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.),… 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
- Trinity Health (Fresno, CA)
- …populations across the acute care continuum. This includes discharge planning, utilization management , care coordination collaboration, and support for resource ... baccalaureate nursing program (BSN) is preferred. 4. Certified Case Manager (CCM) national certification is preferred. 5. Interquel training must be obtained… 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
- LA Care Health Plan (Los Angeles, CA)
- …Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range ... the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and… 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
- Commonwealth Care Alliance (Boston, MA)
- …services, procedures, and facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management (UM) Reviewer is responsible for ... service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has... Manager ) preferred + 1 to 2 years Utilization Management experience required. + 2 or… more
- ERP International (Corpus Christi, TX)
- **Overview** ERP International is seeking a **Registered Nurse (RN)** ** Utilization Manager ** for a full-time position in support of the **Naval Health ... as appropriate. * Participate in all phases of the Utilization Management Program (UMP) and ensure that...Management is required. Full time employment in a nursing field within the last 36 months is mandatory.… more
- 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 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Humana (Louisville, KY)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied… 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
- 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
