- Healthfirst (NY)
- …case management, identifying alternative care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of ... **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which...with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community… more
- Henry Ford Health System (Detroit, MI)
- …equipment. + Innovative Team Structure:Benefit from our new dyad Social Work/RN Case Manager model and remote utilization review setup, allowing you to ... environment? Join our team as a Registered Nurse (RN) Case Manager ! Who We're Looking For: Passionate,...level of care seamlessly. Perks of the Role: + Remote Flexibility:After 6 months, enjoy the option to work… more
- AmeriHealth Caritas (Newtown Square, PA)
- **Medical Director Utilization Management, Pediatrics, REMOTE ** Location: Newtown Square, PA Primary Job Function: Medical Management ID**: 34418 **Job Brief** ... in Pediatrics. 5+ yrs clinical practice exp. 3+ years utilization management exp. pref'd. Your career starts now. We...associates and Providers. + Serves as medical advisor and manager for all clinically related activities. + Assures that… more
- Molina Healthcare (Seattle, WA)
- …Clinical Social Worker (LCSW) + Advanced Practice Social Worker (APSW) + Certified Case Manager (CCM) + Certified in Health Education and Promotion (CHEP) ... with the adult behavioral health system in Washington State and** ** Utilization Management experience is highly preferred.** **_Further details to be discussed… more
- Highmark Health (Dover, DE)
- …Inc. **Job Description :** **JOB SUMMARY** This job supervises a team of Case Manager Supervisors who are charged with promoting quality member outcomes, ... as necessary; may have budgetary responsibility and authority. + Manage a team of Case Manager Supervisors. + Oversee the development of, and updates to,… more
- Elevance Health (Kansas City, KS)
- ** Manager of Utilization Review - Kansas** **Location:** This position will work a hybrid model ( remote and office). Must reside in Kansas and within 50 ... Elevance Health location (Olathe, Kansas City, or Topeka). The ** Manager of Utilization Review** is responsible for...an impact:** + Manages and oversees team responsible in case finding and coordinating cases that involve comorbid conditions.… more
- Molina Healthcare (Long Beach, CA)
- …a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG ... can be flexible and willing to work some weekends and holidays. This is a remote position and you may work from home. Please consider that scheduling flexibility is… more
- GEHA (Lee's Summit, MO)
- …customer experience, sustained by a nimble and efficient organization. The Utilization Management and Oversight Pharmacist will assist with corporate strategy to ... to make our insurance product more competitive and support growth. The Utilization Management and Oversight Pharmacist widely supports the operation of the pharmacy… more
- Stanford Health Care (Palo Alto, CA)
- …clients with the transition from the hospital back into the community. The RN Case Manager is an integral part of the interdisciplinary team which includes: ... This is a hybrid role having a combination of remote and onsite as scheduled. Whether this would be...practice provider, Social Workers, Gerontologist, and Occupational therapist. The Case Manager is a licensed nursing professional… more
- University of Michigan (Ann Arbor, MI)
- RN CASE MANAGER : University Hospital (Care Management) Apply Now **Job Summary** The RN Case Manager assesses, develops, implements, coordinates and ... utilization of resources while promoting quality outcomes. **Organizational Relationships** The RN Case Manager reports directly to the Manager of Care… more
- Veterans Affairs, Veterans Health Administration (Aurora, CO)
- …providing compassionate whole health care to Veterans? Responsibilities The Utilization Management (UM) Registered Nurse (RN) executes position responsibilities that ... demonstrate leadership, experience, and creative approaches to management of complex utilization processes. Practical experience in the application of UM methods and… more
- Humana (Louisville, KY)
- …Management experience in an acute care, skilled or Rehabilitation clinical setting + Certified Case Manager , CCM + Health Plan experience + Medicaid experience + ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Health First (Palm Bay, FL)
- *POSITION SUMMARY:* The RN Case Manager is fully engaged in providing quality/no harm, customer service and stewardship by utilizing advanced clinical skills in ... Florida regulations, and The Joint Commission (TJC) accreditation standards. The RN Case Manager uses sound clinical judgment, working collaboratively with the… more
- Health First (Melbourne, FL)
- *POSITION SUMMARY:* The RN Case Manager is fully engaged in providing quality/no harm, customer service and stewardship by utilizing advanced clinical skills in ... Florida regulations, and The Joint Commission (TJC) accreditation standards. The RN Case Manager uses sound clinical judgment, working collaboratively with the… more
- CVS Health (Trenton, NJ)
- …to make health care more personal, convenient and affordable. Position Summary: This is a remote Case Manager opportunity with 50 to 75% field travel in ... writing and communication skills are required . Fundamental Components/Job Description: The Case Manager is responsible for conducting face to face visits… more
- CVS Health (Austin, TX)
- …. This role is a blended role doing both Case Management and Utilization Management. The RN Case Manager is responsible for telephonically and/or ... care more personal, convenient and affordable. Position Summary This Case Manager RN position is with Aetna's...clinical practice experience as an RN + 6+ months Case Management or Utilization Management experience +… more
- HCA Healthcare (Mcallen, TX)
- …where diversity and inclusion thrive? Submit your application for our Registered Nurse Case Manager PRN opening with Rio Grande Regional Hospital today and ... vary by location._** We are seeking a(an) Registered Nurse Case Manager PRN for our team to...patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and… more
- PruittHealth (Macon, GA)
- …with current, unrestricted license in state of practice (Georgia) required. * Certified Case Manager preferred - Mandatory to apply for CCM certification when ... Ability to work independently and be self-motivated in a remote environment * Manage assigned case load...in a managed care setting focused on experience in utilization review/ case management and at least two… more
- CVS Health (Harrisburg, PA)
- …Health Counselor) Preferred Qualifications + Crisis intervention skills preferred managed care/ utilization review experience preferred + Case management and ... to make health care more personal, convenient and affordable. Position Summary Fully remote in the USA. Shift Monday-Friday standard business hours. No weekends and… more
- CVS Health (Trenton, NJ)
- …to make health care more personal, convenient and affordable. Position Summary This is a remote Clinical Case Manager opportunity with 50 to 75% field travel ... writing and communication skills are required. Fundamental Components/Job Description: The Clinical Case Manager BH is responsible for conducting face to face… more