- Stanford Health Care (Palo Alto, CA)
- …is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse ( UM RN) will be responsible for ensuring the ... the institution, navigating the complexities of patient care and resource utilization management , and education. Primary responsibilities include: 1.… more
- Omaha Children's Hospital (Omaha, NE)
- …meets department guidelines, standards, and policies. + Communicates and collaborates with the Utilization Management ( UM ) Nurse , or other NCMs ... achieved in a timely manner while facilitating appropriate resource utilization and enhancing customer satisfaction. **Essential Functions** + Performs...benefits management . + Understands the NCM and UM Nurse role in revenue cycle … more
- Omaha Children's Hospital (Omaha, NE)
- …councils to address performance improvement and processes. + Communicates and collaborates with the Utilization Management ( UM ) Nurse , or other NCMs as ... achieved in a timely manner while facilitating appropriate resource utilization and enhancing customer satisfaction. **Essential Functions** + Performs...benefits management . * Understands the NCM and UM Nurse role in revenue cycle … more
- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- …while maintaining quality of care. Responsibilities The Registered Nurse (RN) - Utilization Management ( UM ) is responsible for reviewing all inpatient ... Jesse Brown VA Medical Center has a full-time Registered Nurse - Utilization Management position...is a consultant to clinical and administrative staff for UM issues. This RN delivers fundamental knowledge-based care to… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …transform healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral ... caseload. Collaborates with the attending LIP, Clinical Case Manager, nurse , and other members of the treatment team, ACCESS...level of care setting for continued treatment. Employs the utilization management process to assist in setting… more
- Integra Partners (Troy, MI)
- …& Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. The ideal candidate will have a ... industry standards, regulatory requirements, and best practices in clinical documentation and utilization management and update training documents as required +… more
- Elevance Health (Richmond, VA)
- …years acute care clinical experience is required. **Preferred Qualifications** + Previous utilization review/ utilization management experience in a managed ... office.** **HOURS** **: Monday - Friday, 8am - 5pm, EST.** The Nurse Medical Management I is responsible to collaborate with healthcare providers and members to… more
- ManpowerGroup (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management /clinical/or combination; 2 of 4 years ... **Title:** **Managed Care Coordinator UM II** **Location: Columbia SC (Onsite)** **Duration: 3 months** **Pay Range : $31/hr (On W2)** We are looking for a "… more
- LifePoint Health (Las Cruces, NM)
- …utilizes hospital resources in the development of care, discharge planning and Utilization Review. * Utilization Management performs prospective, admissions, ... concurrent review according to standard policies and procedure. * Utilization Management reviews and analyze processes designed...desirable. * Current New Mexico licensure as a Registered Nurse . * Certification as CCM or ACM desired. *_EEOC… more
- Magellan Health Services (Honolulu, HI)
- …Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community ... other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided...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 ... UM Clinical Reviewer 5297 W Copans Rd, Margate,...in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and… more
- VNS Health (Manhattan, NY)
- …Annual * Supervises the day-to-day operations of VNS Health Plans Medical Management clinical and non clinical staff. Makes recommendations to the development, ... utilization , and evaluation of internal processes to ensure customer...in addressing and resolving day-to-day operational issues. * Assists management team in the development of long- and short-… more
- Molina Healthcare (Seattle, WA)
- …Experience with the adult behavioral health system in Washington State and** ** Utilization Management experience is highly preferred.** **_Further details to be ... the following: + Completion of an accredited Licensed Vocational Nurse (LVN) + Licensed Practical Nurse (LPN)...social work. **Required Experience** + 1-3 years in case management , disease management , managed care or medical… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse...Nurse Reviewer RN II, under the purview the Utilization Management ( UM ) Department Leadership ... RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type:...to submit to the department's Quality Assurance Team and UM Management . Duties Facilitates the development, review,… 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 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN...UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare, and… more
- ERP International (Corpus Christi, TX)
- …Utilization Management Program (UMP) and ensure that the UMP meets established Utilization Management ( UM ) standards of care. Assist in coordinating a ... **Overview** ERP International is seeking a **Registered Nurse (RN)** ** Utilization Manager** for a... of specified patients. Perform a full range of utilization management services including referrals, care coordination,… 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 ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied… more
- Humana (Columbus, OH)
- **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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- LA Care Health Plan (Los Angeles, CA)
- …the safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ) RN is responsible for executing the day-to-day ... Supervisor, Utilization Management RN Job Category: Clinical Department:...operations of the UM department, and monitoring the Care Management (CM)… more
- SSM Health (MO)
- …management of daily operations within assigned region(s) or ministries related to the Utilization Management ( UM ) Review area under the direction of ... **Job Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Responsible for daily Utilization Management ( UM ) operations, which includes referrals,… more