- Northeast Georgia Health System, Inc (Gainesville, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:8 Hr Morning - AfternoonNortheast Georgia Health System is rooted in a foundation of improving the ... other members of the healthcare team to assure patient management that efficiently and effectively aligns with patient needs...to ensure services will be covered.Coordinate and communicate with Utilization Review Nurse on a daily, consistent… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:VariesNortheast Georgia Health System is rooted in a foundation of improving the health of our ... all campuses operated by NGHS. Collaborates with the physicians, patients, families, nursing, utilization review and other members of the health care team to ensure… more
- Cambia Health Solutions, Inc (Lewiston, ID)
- …degree in Behavioral Health preferred for behavioral health care management ); or Registered nurse ( RN ) license (must have a current unrestricted ... Care Management Nurse (Future Opportunities)Work from home...Looking For: Every day, Cambia's dedicated team of Care Management RN 's are living our mission to… more
- GHR Healthcare (Atlanta, GA)
- Are you a detail-oriented RN with a knack for navigating complex medical cases? Do you thrive on making critical decisions that impact patient care? Join us as a ... Care Management Coordinator and play a key role in evaluating...business hours) Type: Temp to Hire (Candidates will be remote but need to reside in the tri-state area… more
- Pacer Staffing (Atlanta, GA)
- …regulatory requirements, and HIPAA privacy regulations. . Thorough knowledge of Case Management , Utilization Management , HIPAA Privacy and Security ... Job Summary . Provides Disease Management (DM) services to TRICARE beneficiaries. . The... (DM) services to TRICARE beneficiaries. . The DM nurse will collaboratively assess, plan, implement, coordinate, monitor and… more
- Pacer Staffing (Atlanta, GA)
- …state or territory of the United States, as a Licensed Clinical Social Worker or Registered Nurse US Citizenship Must be able to receive a favorable Interim and ... direction and build group engagement. Technical Skills: Thorough knowledge of Case Management , Utilization Management , TRICARE policies and procedures, HIPAA… more
- US Tech Solutions, Inc. (Columbia, SC)
- …. Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits ... equipment to be prepared. . The position is fully remote after that. . Please list out the top...the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- Amergis (Los Angeles, CA)
- …or service + Performs other duties as assigned/necessary Minimum Requirements: + Registered Nurse or Licensed Practical Nursing license required + Certified ... + Audits medical records and monitors performance measures for health care risk management , sentinel events and trends + Oversees and monitors the development and… more
- Insight Global (Philadelphia, PA)
- …healthcare insurance company local to the Philadelphia area is looking for to hire a fully remote Case Management RN to join their Care management team. ... 100% remotely and have own equipment to work from home 3+ years of case management and utilization management experience Post acute Care experience Discharge… more
- CVS Health (Harrisburg, PA)
- …care more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...of residence + 3+ years of experience as a Registered Nurse + Must possess 1+ years… more
- CVS Health (Jefferson City, MO)
- …care more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. ... external constituents in the coordination and administration of the utilization /benefit management function. * Typical office working...of residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical… more
- CVS Health (Bismarck, ND)
- …schedules may include weekends and holidays and evening rotations._ This is a fully remote Utilization Management Nurse Consultant opportunity. The ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...Qualifications** + 2+ years of clinical experience as an RN + Must have active, current, and unrestricted … more
- Ascension Health (Birmingham, AL)
- …AL ( remote ) At least 3 years of acute care experience and utilization management experience **Benefits** Paid time off (PTO) Various health insurance options ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… 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
- Mayo Clinic (Rochester, MN)
- …and inclusion, and provides the resources you need to succeed. **Responsibilities** The Registered Nurse ( RN ) Case Manager works within an interdisciplinary ... by ensuring appropriate utilization management , care coordination, resource utilization , and clinical documentation. The RN Case Manager will function… 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
- Banner Health (Gilbert, AZ)
- …include working in an acute care setting within the past 12 months as a Registered Nurse in the specialty area. Banner Registry and Travel physician practice ... (HUC). Clinical Care Operations is the hub of patient management for the campus, including: bed assignment, unit staffing...require a minimum of one year experience as a Registered Nurse in a physician practice or… more
- AmeriHealth Caritas (Myrtle Beach, SC)
- ** REMOTE | Care Manager II Registered Nurse (BSN) - Foster Care Program -SC** Location: Myrtle Beach, SC Primary Job Function: Medical Management ID**: ... accurate documentation of Member interactions in ACFC electronic care management platforms where applicable. 6. Monitor appropriate utilization...is required and must hold a current and unrestricted ** Registered Nurse ( RN )** license in… more
- Geisinger (Danville, PA)
- …Specialty Training Program-Nursing (Required) Experience Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania; ... Job Summary Geisinger is proud to offer a full time Inpatient RN up to $24,000 hiring incentive for eligible candidates! $40.00 minimum hiring rate with increased… more
- Geisinger (Wilkes-Barre, PA)
- …(Required), Bachelor's Degree-Nursing (Preferred) Experience Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania; ... Job Summary Geisinger is proud to offer an Inpatient RN a hiring incentive up to $26,000 for eligible candidates! $35.88 minimum hiring rate with increased rates for… more
