- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager ** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 Your career starts now. We ... 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
- Dartmouth Health (Lebanon, NH)
- Overview The Manager of Utilization Management is responsible for day to day operations of the utilization review program at multiple Dartmouth Health ... leadership, communication and computer skills desired. Required Licensure/Certifications - Licensed Registered Nurse with NH eligibility - BLS certification… more
- Humana (Jefferson City, MO)
- …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 IL,… 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
- Sharp HealthCare (San Diego, CA)
- …Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized...clinical experience as defined by the CBA. + California Registered Nurse ( RN ) - CA… more
- Healthfirst (NY)
- **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes: + Pre-certification performing risk-identification, ... Negotiates rates with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community resources to… more
- Prime Healthcare (National City, CA)
- …education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/175861/**case- manager - rn utilization - management ... an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute… more
- Prime Healthcare (Montclair, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/175009/case- manager -%28rn%29 utilization - management ... an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute… more
- Prime Healthcare (North Las Vegas, NV)
- …computer skills. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/174491/case- manager -%28rn%29 utilization - management ... an accredited school of nursing and a current state Registered Nurse license2. Grandfathered prior to April...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …years of progressively responsible and directly related work experience License/Certification: CA Registered Nurse ( RN ) Knowledge, Skills, & Abilities These ... include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness… more
- ERP International (Corpus Christi, TX)
- **Overview** ERP International is seeking a ** Registered Nurse ( RN )** ** Utilization Manager ** for a full-time position in support of the **Naval ... of this position, it must be directly related to referral/ utilization management . License:** Active, unrestricted RN license Board Certification:**… more
- Molina Healthcare (NV)
- …not a compact state at this time.** **Prior experience with managed care (Medicaid, Medicare) Utilization Management processes and 3 + years in management / ... performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.),… more
- UNC Health Care (Hillsborough, NC)
- **Description** RN Utilization Manager is responsible for clinical reviews for medical necessity for both admission and continuing stay patients during the ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to… more
- RWJBarnabas Health (Livingston, NJ)
- Case Manager Registered Nurse ( RN ), Case...setting + Minimum of one year experience in Case Management / Utilization Management or Home Care ... Hills Road, Livingston, NJ 07039 Job Summary: The Case Manager Registered Nurse develops safe...population across the continuum of illness. Assumes responsibility for utilization management and monitoring process. Conducts admission… more
- Cedars-Sinai (Los Angeles, CA)
- …condition of continued employment. **Req ID** : 5329 **Working Title** : Registered Nurse - Utilization Management - PER DIEM 8 Hour Days **Department** ... fro an accredited nursing program required. Bachelors Degree in Nurse preferred. California RN License required. **Experience:**...: Utilization Management **Business Entity** : Cedars-Sinai Medical… 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
- Humana (Louisville, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- HCA Healthcare (Richmond, VA)
- **Description** **Introduction** Do you have the career opportunities as a(an) Case Manager Registered Nurse RN you want in your current role? We invest ... RN years demonstrated leadership experience + Commercial Utilization Management and/or Case Management ...path, we encourage you to apply for our Case Manager Registered Nurse RN… more
- LifePoint Health (Johnstown, PA)
- * Registered Nurse ( RN ), Case Manager * Job Type:Full-time| Days/Nights/Weekends ** *Department/Unit Summary* Case Management plays an important role ... in the care of hospitalized patients. Our team of RN Case Managers, Social Workers, Utilization Review...employment. **Job:** **Nursing* **Organization:** ** **Title:** * Registered Nurse ( RN )- Case Manager * **Location:**… more
- AdventHealth (Celebration, FL)
- …safe transitions, patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the ... competencies of this role. The RN Care Manager facilitates the collaborative management of patient...valid State of Florida or multistate license as a Registered Nurse + 2 years of medical/… more