- InnovaCare (San Juan, PR)
- …MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization of healthcare ... within forty-eight (48) hours of having performed the first concurrent review of notified admission cases.4. On a daily...documents, and codes and reports the data to the Utilization Management Inpatient Coordinator and Inpatient Nurses.13.… more
- Centene Corporation (Austin, TX)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Centene Corporation (Sacramento, CA)
- …Knowledge of Medicare and Medicaid regulations preferred. + Knowledge of utilization management processes preferred. **License/Certification:** **For Health Net ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- Summary The Emergency Department Utilization Management (ED-UM) Registered Nurse (RN) is responsible for providing competent, evidence-based practices within ... levels of care for the incoming patients Preferred Experience: Experience in utilization management /case management /clinical documentation, critical care, or… more
- Crouse Hospital (Syracuse, NY)
- Utilization Management Registered Nurse has well-developed knowledge and is proficient with standard Utilization Review processes. The Utilization ... commercial and government payers. This individual is responsible for concurrent and continued stay Utilization Management...+ Required: + Currently licensed as a Registered Professional Nurse in New York State. + Associates Degree +… more
- Martin's Point Health Care (Portland, ME)
- … required; BSN preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care or hospital environment required ... has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring… more
- Katmai (Usaf Academy, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in… more
- Ascension Health (Manhattan, KS)
- **Details** + **Department:** Utilization Management + **Schedule:** Full Time, 40 hours weekly, Monday - Friday 7:30am - 4pm + **Hospital:** Ascension Via ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- CVS Health (Santa Fe, NM)
- …**Preferred Qualifications** + 1 year of varied UM ( utilization management ) experience within an inpatient/outpatient setting, concurrent review or prior ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Utilizes clinical experience and skills in a… more
- ERP International (Nellis AFB, NV)
- …No Call, No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality ... **Overview** ERP International is seeking **Registered Nurse (RN) Utilization Managers** for full-time...disciplines to include discharge planning and referrals for case management . * Utilization management duties… more
- Sharp HealthCare (San Diego, CA)
- …the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. This position ensures ... (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited...Degree in a health related field. + 3 Years Utilization Management or case management … more
- Cleveland Clinic (Vero Beach, FL)
- …May design and initiate special projects as supervised by the Team Manager. Utilization Management Specialist Join our team at Cleveland Clinic Indian River ... career with one of the most respected healthcare organizations in the world. Utilization Management (UM) Specialists perform UM activities, such as admission… more
- Sharp HealthCare (San Diego, CA)
- …Qualifications** + Bachelor's Degree in Healthcare or a related field + 3 Years Utilization Management or case management within a hospital or payer ... Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American Case… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II (After Hours Evening) Job Category: Clinical Department: Utilization Management Location: Los Angeles, ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- WellSpan Health (York, PA)
- … principles throughout the System. Duties and Responsibilities + Oversees the utilization management process for preauthorization, concurrent review, denials ... 5 years In leadership experience. Required + 3 years Utilization Management Experience. Preferred Licenses: + Licensed Registered Nurse Preferred Knowledge,… more
- Sharp HealthCare (San Diego, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... as Allscripts.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- Actalent (Doral, FL)
- Utilization Management Nurse Job...members when applicable. Essential Skills + Clinical review + Utilization management + Concurrent review ... Description The role of the Utilization Management (UM) Nurse is to promote quality,...the care continuum. Responsibilities + Perform prospective, retrospective, or concurrent medical necessity reviews for an assigned panel of… 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 ... level of care setting for continued treatment. Employs the utilization management process to assist in setting...regarding transition to alternative levels of care. + Perform concurrent utilization review applying identified criteria at… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours week. + **Hospital:** Ascension Saint Thomas + **Location:** ... Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role, you'll… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more