- Covenant Health (Bangor, ME)
- …the supervision 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 advocate... conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed… 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 ... coordination of care. In this role you will perform utilization review while assuring the delivery of...RN License and BLS certification + Recent experience in case management, utilization management and discharge planning… more
- Morris Hospital (Morris, IL)
- …using evidenced-based clinical guidelines. Performs duties in accordance with the Utilization Review Plan. Demonstrates thorough knowledge of performance measure ... in acute hospital setting. + Strong clinical expertise. + Prior experience in utilization management or case management preferred. + Ability to maintain… more
- LifePoint Health (Danville, VA)
- *Registered Nurse, RN - Utilization Review Case Manager * Job Type:Full Time|Days *$10,000 Sign-on Bonus Eligibility for Full-Time, Bedside RNs* ** Must ... have Utilization Review experience.** ** * ** *Your...offering safe discharge planning is the use of a Utilization RN and Case Manager ...the use of a Utilization RN and Case Manager RN, in conjunction with a… more
- University of Miami (Miami, FL)
- …please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Utilization Review Case Manager ... of Miami is currently seeking a Prior Authorization Nurse Case Manager . The incumbent purose is to...forth by the payer or clinical guidelines + Accurate review of coverage benefits and payer policy limitations to… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical ... Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...Case Manager experience as well as Utilization Review experience ( review medical… more
- Avera (Sioux Falls, SD)
- …from Avera facilities as Swing Bed transfers. + Supports compliance with Utilization Review Process. Case Manager will have ongoing conversation with ... Transfer Center RN and accepting physician. The Transfer Center Case Manager reviews patients for medical necessity,...Utilization Review staff on patients status and ongoing coverage +… more
- Community Health Systems (Franklin, TN)
- …identified issues and trends or escalated challenges. Communicates Utilization Review information with facility Case Manager Directors, proactively ... **Job Summary** The Manager of Utilization Review oversees a team of utilization review nurses and coordinators, ensuring compliance with clinical… more
- CVS Health (Lewisburg, WV)
- …+ Foster care experience + Crisis intervention skills + Managed care/ utilization review experience + Certified Case Manager (CCM) certification + ... care more personal, convenient and affordable. **Position Summary** The Case Manager RN (CM RN) is responsible...face member visits + Using clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more
- Prime Healthcare (Lynwood, CA)
- …education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/189323/ case - manager utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care… more
- MD Anderson Cancer Center (Houston, TX)
- …in coordinating care for high risk and complex patients. Preferred experience: Utilization review experience Licensure / Certification Required: Current State of ... patient receives care * Ensure appropriate payment of services that includes review of the appropriate patient class, providing clinical reviews to payers utilizing… more
- Mount Sinai Health System (New York, NY)
- …Requirements** + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + ... **Job Description** **RN/ Case Manager MSH Case ...a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case… more
- Mount Sinai Health System (New York, NY)
- …preferred. + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + ... **Job Description** The Case Manager (CM) will be responsible...1. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case… more
- Dignity Health (Stockton, CA)
- …atmosphere that fosters communication trust and personal growth. **Responsibilities** **Position Summary:** Case Manager 1 assists Case Managers in ... to patients and their families acting as liaison between the case manager treatment team and physicians referral sources outside therapists community agencies… more
- Lowe's (Charlotte, NC)
- …of experience in a clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Experience in a ... Office + Unrestricted RN license in home State + CCM - Certified Case Manager + CRRN - Certified Rehabilitation Registered Nurse + CDMS - Certified Disability… more
- LA Care Health Plan (Los Angeles, CA)
- …California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or… more
- UNC Health Care (Raleigh, NC)
- **Description** **Full time exempt, 40 hours per week Utilization Manager - Medical necessity review for Surgical admissions** Become part of an inclusive ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical...of patient data and treatments. Communicates daily with the Case Manager to manage level of care… more
- Alight (NJ)
- …+ 5+ years medical advisory experience in occupational health, worker compensation, disability, health case management, or utilization review . + 2+ years as ... Additionally, demonstrate excellent problem-solving skills when questioned on your case management plans. + Consulting on medical, behavioral health,...a Clinical Case Manager . Additionally, possess a working knowledge of disability, client… more
- Helio Health Inc. (Syracuse, NY)
- …to track, review , and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our ... issues. To support the mission of Helio Health, theUtilization Case Manager will enhance the program's efforts...Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care,… more
- Prime Healthcare (Weslaco, TX)
- …#registerednurse #casemanagement Connect With Us! (https://careers-primehealthcare.icims.com/jobs/188814/registered-nurse- case - manager utilization ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...a related field. At least one year experience in case management, discharge planning or nursing management;2. CCM or… more