- PIH Health (Downey, CA)
- The RN Case Manager manages a continuum of care from pre-admission through post-discharge for assigned patients. Assure that patients and families proceed ... the course of hospitalization. Focus of the position is the appropriate utilization of hospital services, maximizing reimbursement from all third party payors, and… more
- PIH Health (Bell, CA)
- …reparation/transfer of out-of-network patients from PHWH to the patient's contracted facilities. The RN Access Case Manager performs utilization review with ... The RN Access Case Manager provides care...The RN Access Case Manager provides care coordination which emphasizes positive partnerships...level of care. The RN Access Case Manager works to ensure appropriate utilization of… more
- UNC Health Care (Raleigh, NC)
- …care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management ... and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and...date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North… more
- UNC Health Care (Hendersonville, NC)
- …the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge review ... met and care delivery is coordinated. The UM completes utilization reviews in accordance with federal regulations and the...Required * Must be licensed to practice as a Registered Nurse in the state of North… more
- Independent Health (Buffalo, NY)
- …plan managed care operations required; multi-dimension project management experience preferred. + Registered Nurse ( RN ) with active, unrestricted NYS license ... perks, benefits and commitment to diversity and inclusion. **Overview** The Program Manager - Utilization Management (UM) will be accountable for the management,… more
- Beth Israel Lahey Health (Plymouth, MA)
- …not just taking a job, you're making a difference in people's lives.** MANAGER , UTILIZATION REVIEW & DENIALS MGMT **Job Description:** Beth Israel Deaconess ... to level of care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely response to denials. + Maintains… more
- UCLA Health (Los Angeles, CA)
- …for assessing and coordinating care for a diverse group of patients. This in-patient utilization review case manager position will work on-site at our UCLA ... coordination of care. In this role you will perform utilization review while assuring the delivery of concurrent and...accepted for current UCLA Health Nursing staff) + CA RN License and BLS certification + Recent experience in… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... from payors for additional clinical documentation. |Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… more
- Covenant Health (Bangor, ME)
- …of the VP of Accountable Care Operations & Population Health Strategy the Utilization Review Case Manager will work collaboratively with other members of ... the healthcare team. The nurse case manager also acts as an... conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed… more
- Beth Israel Lahey Health (Burlington, MA)
- … Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse ( RN ) Case Manager for Hospital at Home Care Transitions coordinates ... to meet the needs of the department. **Minimum Qualifications:** Education: * Registered Nurse , Bachelors Degree or commensurate experience preferred. Licensure,… more
- UPMC (Hanover, PA)
- …required with 4-6 weeks of hire. UPMC approved Care Management certification preferred. + Registered Nurse ( RN ) + Act 34 *Current licensure either in ... **UPMC is hiring a part time Professional Care Manager for our Utilization Review department...preferred. **Licensure, Certifications, and Clearances:** Current licensure as a Registered Professional Nurse either in the state… more
- Ochsner Health (New Orleans, LA)
- …a difference at Ochsner Health and discover your future today!** This job is a registered Nurse with a diverse medical background, who is able to determine the ... Contents are subject to change at Ochsner's discretion. **Education** Required - Registered Nurse Diploma or equivalent **Work Experience** Required - 1… more
- Ochsner Health (New Orleans, LA)
- …a difference at Ochsner Health and discover your future today!** This job is a registered Nurse with a diverse medical background, who is able to determine the ... Contents are subject to change at the company's discretion. **Education** Required - Registered Nurse Diploma or equivalent **Work Experience** Required - 1 year… more
- McLaren Health Care (Port Huron, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay ... Functions and Responsibilities as Assigned:** 1. Collaborates with the UM RN to determine the appropriate hospital setting (inpatient vs. observation) based… more
- McLaren Health Care (Detroit, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay ... Functions and Responsibilities as Assigned:** 1. Collaborates with the UM RN to determine the appropriate hospital setting (inpatient vs. observation) based… more
- Ascension Health (Baltimore, MD)
- …education, experience, location, qualifications and comparison with associates in similar roles_ ** Registered Nurse , Certified Case Manager (CCM, ACM, URAC) ... **Details** + **Department:** Utilization Management + **Schedule:** On-site, Monday-Friday, 8:00AM-4:30PM. Must...of staff **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date… more
- Elevance Health (Washington, DC)
- Manager ll HCMS - Utilization and Case Management (JR142403) **Location:** This position requires travel to our Washington, DC office 4 days each week. The ... reside within 50 miles and a 1 hour commute of the above office. The ** Manager ll HCMS** is responsible for managing a team of physical health practitioners in the… more
- Trinity Health (Lavonia, GA)
- **Employment Type:** Full time **Shift:** **Description:** The RN Case Manager ( RN CM), works in collaboration with a multidisciplinary team by identifying ... care throughout hospitalization in compliance with CMS and organizational utilization management requirements. RN CM helps to ensure medical necessity is met by… more
- Trinity Health (Athens, GA)
- …intensity of service for patients to ensure appropriate and timely utilization of hospital services. **Licensure/Certification/Registration:** Current GA RN ... in a hospital setting and a minimum of 1 year in case management, utilization management, or discharge planning preferred for RN . Certification in case… more
- Pacific Medical Centers (Renton, WA)
- …order to assure cost effective, appropriate utilization of health care resource. Utilization Nurse / Case Manager manages, directs, and coordinates the ... best people, we must empower them. **Required Qualifications:** + Upon hire: Washington Registered Nurse License. + 5 years Clinical experience. + Utilization… more
