- Matrix Providers (Aurora, CO)
- Registered Nurse ( RN ) - Utilization Management Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... schedules. Matrix Providers is hiring a Registered Nurse ( RN ) - Utilization Management to join our team of talented professionals who provide… more
- 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 (Cheyenne, WY)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence… 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
- CareFirst (Baltimore, MD)
- …is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... based on business needs and work activities/deliverables that week. The Director, Utilization Management provides strategic leadership of the utilization … more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Crouse Hospital (Syracuse, NY)
- …and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse ( RN ) to track and manage data ... occasional weekends (typically requires 6 weekends a year). Utilization Management Registered Nurse ( RN ) Position Responsibilities: + Works… more
- Dignity Health (Rancho Cordova, CA)
- …clinical case management department.( Utilization Management ,Denial Management ,Care Coordination) + Current California RN license + National ... You can also follow us on Twitter and Facebook. **Responsibilities** The Utilization Management (UM) Manager is responsible for managing day-to-day UM… 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
- CVS Health (Columbus, OH)
- …occasionally per the need of the department.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... to make health care more personal, convenient and affordable. **Position Summary:** This Utilization Management (UM) Nurse Consultant role is 100% remote… more
- CVS Health (Olympia, WA)
- …1 holiday per year). There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... to make health care more personal, convenient and affordable. **Position Summary** **This Utilization Management (UM) Nurse Consultant role is fully remote… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …AND EXPERIENCE** BSN (Bachelor of Science in Nursing) Minimum 5 years clinical experience as Registered Nurse ( RN ) Minimum 2 years managed care or equivalent ... bonus eligibility, and more! **Responsibilities** **JOB SUMMARY/PURPOSE** Provides leadership to Utilization Management RNs, Denials RNs and support staff to… more
- Independent Health (Buffalo, NY)
- …managed care operations required; multi-dimension project management experience preferred. + Registered Nurse ( RN ) with active, unrestricted NYS license ... perks, benefits and commitment to diversity and inclusion. **Overview** The Program Manager- Utilization Management (UM) will be accountable for the management… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …medical necessity criteria and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning + Understand and ... to obtain and/or share information relating to benefits and the BCBSMA utilization management process + Collaborate with members/families, providers, medical… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours week. + **Hospital:** Ascension Saint Thomas + **Location:** ... TN market. We're looking for an experienced Director of Utilization Management to join our team! In...all clients. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Tennessee Board… more
- Hackensack Meridian Health (Holmdel, 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
- Ascension Health (Tulsa, OK)
- **Details** + **Department:** Utilization Management + **Schedule:** FT, Monday-Friday, 8am-5pm + **Hospital:** Ascension St. John Medical Center + **Location:** ... Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. Responsibilities: +… more
- CVS Health (Austin, TX)
- …operation and work schedules 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...of clinical experience in acute or post-acute setting + Utilization management is a 24/7 operation. Work… 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 ... achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Humana (Louisville, KY)
- …and help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Nurse 2 who will utilize clinical nursing skills to ... benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work...30 miles of Lexington or Louisville, Kentucky.** + Licensed Registered Nurse ( RN ) in the… more