- Prisma Health (Columbia, SC)
- …Degree in Nursing. BSN preferred.One year experience as a registered nurse .Required Licensure/Registrations/CertificationsLicensed to practice as a ... and/or all the nursing units within the scope of RN practice. This scope includes medical-surgical, telemetry, progressive and...Registered Nurse in South CarolinaIn Lieu Of The Above Minimum… more
- 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
- Humana (Salem, OR)
- …a part of our caring community and help us put health first** The Manager , Utilization Management Nursing utilizes clinical nursing skills to support ... communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… 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
- Providence (Mission Hills, CA)
- **Description** The Manager of Utilization Management provides a key role in leading, facilitating and managing the hospital utilization management ... The Manager assists the Regional Director of Utilization Management , Appeals & Clinical Training through...related area + Upon hire: California Registered Nurse License + 5 years Healthcare management … more
- CVS Health (Springfield, IL)
- …**Position Summary:** The Associate Manager is responsible for oversight of Utilization Management /Case Management staff. This position is responsible ... department + 3+ years inpatient clinical experience as a Registered Nurse + 3+ years of Managed...years of Managed Care experience + 1+ years of Utilization Management experience + 1+ year Leadership… more
- Trinity Health (Silver Spring, MD)
- …travel paid._** **Minimum Licensure/Certification Required (if applicable):** + State of Maryland license as a Registered Nurse + RN with BSN or RN with ... time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review, under the supervision and in collaboration with the Director,… 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 ... a self-motivated, detail-oriented, service-driven leader with: + Current unrestricted RN licensure in CA required + Bachelors of Science,...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- Corewell Health (Grand Rapids, MI)
- …+ 5 years of relevant clinical experience in acute care or office setting + LIC - Registered Nurse ( RN ) from the State of Michigan upon hire Preferred + 5 ... Job Summary Effectively leads and motivates the Utilization Management team to ensure the goals and standards of the department are being met. This position is… 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
- Sharp HealthCare (San Diego, CA)
- …Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered Nursing ... experience + 3 Years recent case management , utilization review, care coordination experience + California Registered Nurse ( RN ) - CA Board of… more
- Cleveland Clinic (Vero Beach, FL)
- … Manager . May design and initiate special projects as supervised by the Team Manager . Utilization Management Specialist Join our team at Cleveland Clinic ... of the most respected healthcare organizations in the world. Utilization Management (UM) Specialists perform UM activities,...of professional nursing. + Current state licensure as a Registered Nurse ( RN ). + Basic… more
- Elevance Health (FL)
- **JR133557 Manager II Behavioral Health Services ( Utilization Management for Behavior Analysis Services)** Responsible for Behavioral Health Utilization ... Candidate will be responsible for the oversight of the utilization management team. + Responsible for a...ALL FUNCTIONS: Requires current, active, unrestricted license such as RN , LCSW (as applicable by state law and scope… 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...date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North… more
- Trinity Health (Silver Spring, MD)
- …MD **Description:** + Full-Time 8am - 4:30pm + Reporting to the Director of Care Management + The RN Manager is responsible and accountable for the ... will need:** + State of Maryland license as a Registered Nurse + BSN required; MSN Degree...required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At… more
- BronxCare Health System (Bronx, NY)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients,… more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager (Ohio Resident)** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 **Job Brief** ... Officer for the Ohio Market, this position is representing Utilization Management (UM) in state interactions/audits, validation...RN license in OH. + 3+ years of utilization /case management experience in relevant scope preferred,… more
- Sharp HealthCare (San Diego, CA)
- …Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... clinical experience as defined by the CBA. + California Registered Nurse ( RN ) - CA...Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager… more
- HCA Healthcare (Richmond, VA)
- …at Chippenham Hospital have the opportunity to make a real impact. As a Registered Nurse RN Case Manager you can be a part of change. **Benefits** ... by location._ We are seeking a Registered Nurse RN Case Manager for...experience in a hospital setting preferred.** + **Previous case management or utilization review experience preferred.** CJW… more
- HCA Healthcare (Richmond, VA)
- …**Are you passionate about delivering patient-centered care?** Submit your application for Case Manager Registered Nurse RN position and spend ... payers and maintains legible documentation as directed by the Utilization Management Plan + As a member...your career! We are interviewing candidates for our Case Manager Registered Nurse RN… more
