- Molina Healthcare (Bronx, NY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... with data collection/reports** **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **NY… more
- Molina Healthcare (Los Angeles, CA)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... of illness and the site of service. **We are seeking a candidate with a RN license and managed care UM experience-required. Prior Inpatient review experience and… more
- LifePoint Health (Las Cruces, NM)
- …Professionals or InterQual is desirable. * Current New Mexico licensure as a Registered Nurse . * Certification as CCM or ACM desired. *_EEOC Statement_*: ... local law./ **Job:** **Nursing* **Organization:** **Memorial Medical Center* **Title:** * RN Case Manager - UM - PRN*...Medical Center* **Title:** * RN Case Manager - UM - PRN* **Location:** *New Mexico-Las Cruces* **Requisition ID:**… more
- United Methodist Communities (Camden, NJ)
- …| Camden, NJ, USA | Hourly | Per Diem RN : Registered Nurse UMC -...and orientation process is quick and easy Abo ut UM C: + Our Mission is to serve our ... have flexibility to work as little or as much as you choose. Requirements for an RN : Registered Nurse : + Cover an open shift as assigned and agreed upon +… more
- University of Virginia (Charlottesville, VA)
- …of the healthcare team to promote and adhere to regulatory compliance. The UM RN conducts initial concurrent and retrospective medical necessity reviews. All ... and Outpatient Setting. Under general direction: The Utilization Management RN serves as a leader resource in the Utilization...care hospital experience. Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia… more
- Magellan Health Services (Honolulu, HI)
- …State Licensure - Care Mgmt, PT - Physical Therapist, State Licensure - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management of crisis...reports with audit results. Presents findings at provider, customer, UM and CM meetings as needed. + Audits and… more
- ProMedica Health System (Sylvania, OH)
- …applicable nursing experience License: A current, active, and unrestricted licensure as a Registered Nurse in the state of practice is required. Certification: ... Position Summary: The RN Acute Care Navigator is responsible for direct...Care Coordination Plan, updates as appropriate. 12. Collaborates with UM team, as appropriate and applies clinical understanding of… more
- Texas Health Resources (Arlington, TX)
- ** RN / Registered Nurse -Utilization Management, Clinical Reviews** **Work location:** 100% remote but must live in Texas, preferably in the Dallas-Fort Worth ... of medical necessity criteria preferred + 1 year of UM experience in the last three years preferred **Licenses...the last three years preferred **Licenses and Certifications** + RN - Registered Nurse Current… more
- Molina Healthcare (Long Beach, CA)
- …interpersonal skills **Job Qualifications** **Required Education:** Completion of an accredited Registered Nurse ( RN ) Program **Required Experience:** + ... Marketplace programs. **We are seeking a candidate with a RN license and UM experience. Prior Case...Review experience **Required Licensure or Certification:** Active, unrestricted State Registered Nurse ( RN ) License in… more
- Banner Health (AZ)
- …activities MINIMUM QUALIFICATIONS Completion of an Associate's degree in Nursing. Requires current Registered Nurse ( RN ) license in state worked. Five years ... experience and skills to BPN. As the Manager of RN Medical Management Services for Banner Plans & Networks,...recommendations for improvement. 3. Communicates with PA, CM and UM departmental staff and management to ensure that there… more
- Ciena Healthcare (Escanaba, MI)
- …and strong teamwork abilities. Responsibilities + Supervises nursing care provided by Registered Nurses ( RN ), Licensed Practical Nurses (LPN), Certified Nursing ... on a per pay period basis) Are you an RN looking for a leadership role? Do you have...for leading and teaching other skilled nursing staff? The RN Unit Manager provides, plans, coordinates or manages nursing… more
- United Methodist Communities (Pitman, NJ)
- 75 per visit | Posted 09-Aug-2024 (EST) | Pitman, NJ, USA | Other | Per Diem RN : Registered Nurse - Home Care Visiting Nurse Serving clients in Monmouth ... Streamlined orientation process + Supportive and encouraging team! Requirements: RN 's must be Covid vaccinated and boosted and have...and valid Driver's License is also required. Abou t UM C: + Our Mission is to serve our… more
- Apex Health Solutions (Houston, TX)
- …of Nursing) Licenses/Certifications: Current, unrestricted Texas licensure to practice as a Registered Nurse or Licensed Vocational Nurse required and ... Summary: The UM Reviewer serves as a contact and resource...carrying out day today pre-authorization functions. The Utilization Review Nurse will also be responsible for issuing pre-authorization approvals/denials,… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day timely ... clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets… more
- Magellan Health Services (Honolulu, HI)
- …- Licensed Professional Counselor - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... with necessary degrees: CEAP, LMSW, LCSW, LSW, LPC or RN . Minimum 2 years experience post degree in healthcare,...General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience… more
- Centers Plan for Healthy Living (Margate, FL)
- …Plan For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... UM Clinical Reviewer 5297 W Copans Rd, Margate,...education, and preventative interventions are maintained. Qualifications: + Active RN license, entry level RN welcome +… more
- The Arora Group (Twentynine Palms, CA)
- Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse ( RN ) Case Manager near Palm Springs, California, to provide care to ... 80 hours per two week period. DUTIES OF THE REGISTERED NURSE CASE MANAGER ( RN ):...monitoring. + Integrate case management (CM) with utilization management ( UM ) and disease management as needed. Integrate nursing case… more
- The Arora Group (Coronado, CA)
- Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse ( RN ) Case Manager in Coronado, California, to work at Coronado Naval ... - Fri between 7:30AM - 8:00PM. DUTIES OF THE REGISTERED NURSE CASE MANAGER ( RN ):...for community resources. + Integrate CM and utilization management ( UM ) and integrating nursing case management with social work… more
- Kepro (AR)
- …deliverables and provide day-to-day oversight to manage multiple areas of the UM program and oversee the implementation of clinical contract requirements and ... Medicaid rules and regulations. Job Responsibilities: + Responsible for UM reviews such as: Inpatient (Under 21) and Outpatient...+ Active, unrestricted Licensed in one of the following: RN in Arkansas or compact state, Social Work, Licensed… more
- Elevance Health (Kansas City, KS)
- **Director I HCMS - UM /CM - Kansas** **Location:** This position will work a hybrid model (remote and office). Must reside in Kansas and within 50 miles/1hour ... Health location (Olathe, Kansas City or Topeka) The **Director I HCMS - UM /CM** is responsible for managing the utilization or care management process for one… more