- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Nurse , you will be responsible for: + Ensuring appropriate, cost-effective, and high-quality ... care for New Century Health Plan members + Conducting utilization management (UM) activities in accordance with...BSN or MSN degree, required * Current valid California RN license, required * Two or more years of… more
- Stanford Health Care (Palo Alto, CA)
- …Skills and Abilities** + Knowledge of principles and best practices of case management , utilization review , social work, care coordination and discharge ... leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by...to address them. **Licenses and Certifications** + Nursing / RN - Registered Nurse -… more
- Ascension Health (Kalamazoo, MI)
- …management experience preferred. **Additional Preferences** There will be a dual focus on case management and utilization review in this position + Case ... prior to hire date or job transfer date. + Registered Nurse credentialed from the Michigan Board...Management experience - Strongly preferred + Utilization Review experience - Strongly preferred **Why… more
- MetroHealth (Cleveland, OH)
- …patient care by ensuring the appropriate level of care at the point of entry. The utilization review nurse will work on defined patient populations and is ... degree in Nursing (applies to placements after 1/1/2017). Current Registered Nurse License State of Ohio. Minimum... skills. Preferred: Two years of experience with case management , utilization review . Physical Demands:… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- US Tech Solutions (Chicago, IL)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in...+ Do you have experience with Utilization Review ? + Do you have an Active Registered… more
- US Tech Solutions (May, OK)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... . 1+ years of inpatient hospital experience . Registered Nurse in state of residence ....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST HAVE… more
- Matrix Providers (Aurora, CO)
- Registered Nurse ( RN ) - Utilization Management Location: Aurora, CO, United States Healthcare Provider Type : Nursing START YOUR APPLICATION ... is hiring a Registered Nurse ( RN ) - Utilization Management to...care clinical setting and 12 months consecutive experience in utilization management , utilization review… more
- Fairview Health Services (St. Paul, MN)
- …Job Description** **Job Expectations:** + Perform and document timely and accurate utilization management review to ensure compliance with all ... **Required** + Bachelor's degree in Nursing + 3-5 years Utilization Review or Case Management ...years of acute care hospital nursing experience. + Current RN License **Preferred** + Minimum of 1-year Epic experience.… more
- Community Health Network (Indianapolis, IN)
- Registered Nurse ( RN ) Case Manager/ Utilization Review - North Emergency Job Ref 2408203 Category Nursing Job Family Case Manager Department Case ... Review position available in the Emergency Department. The Registered Nurse Case Manager is responsible for...inpatient and observation services. The RN Case Manager/ Utilization Review RN also assists… more
- Baylor Scott & White Health (Columbus, OH)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- CaroMont Health (Gastonia, NC)
- …license to practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management , Quality and/or Case Management ... to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments,… more
- UCLA Health (Los Angeles, CA)
- …+ experience in an HMO environment + Thorough knowledge of health care industry, utilization review , utilization management , and concurrent review ... at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management...following major functions: + Pre-service Authorizations/Denial Letters + Concurrent Review + Continuity of Care + Retro Claims +… more
- McLaren Health Care (Detroit, MI)
- …degree in coding/medical records/billing or healthcare related field + Two years of case management or utilization review , billing, or coding experience + ... **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the...based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …utilization of resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of ... to the treatment team, Director of Utilization Management , and the Medical Director. + Review ...Degree **Licenses and Certifications Preferred:** + NJ State Professional Registered Nurse License or NJ Licensed Social… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management /clinical/or combination; 2 of ... effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is...the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- CVS Health (Harrisburg, PA)
- …through Friday 8:30-5pm EST. No weekends or holidays. - 1+ years of utilization review / utilization management required **Preferred Qualifications** ... in the state of residence (LMSW, LCSW, LISW, LPC, or comparable) or Registered Nurse licensure with psychiatric specialty, certification, or experience in state… more
- Prime Healthcare (Ontario, CA)
- … Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according to ... A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management ...with a large Health Plan + An active CA Registered Nurse license + Current BCLS (AHA)… more
- RWJBarnabas Health (Livingston, NJ)
- Case Manager Registered Nurse - Case Management (FT/Days)Req #:0000179789 Category:Nursing Status:Full-Time Shift:Day Facility:Cooperman Barnabas Medical ... Road, Livingston, NJ 07039 Job Summary: The Case Manager Registered Nurse will coordinate discharge planning to...on other classifications of patients as designated by the Utilization /Case Management Review Plan. Coordinates… more
- Ascension Health (Baltimore, MD)
- …and salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing ... location, qualifications and comparison with associates in similar roles_ ** Registered Nurse , Certified Case Manager (CCM, ACM,...the areas of utilization criteria, appeal and review process, and case management system documentation.… more