• Care Manager RN - Utilization Management

    Highmark Health (Harrisburg, PA)
    resource utilization, identification of opportunities for referral to a Health Coach/ case management , and identification and resolution of quality issues. ... and refer members whose healthcare outcomes might be enhanced by Health Coaching/ case management interventions. + Employ collaborative interventions which focus,… more
    Highmark Health (12/18/25)
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  • RN Delegated Care Management Monitor…

    Elevance Health (Raleigh, NC)
    …+ Manage and control healthcare costs for the designated population through integrated case management . + Review member care plans and ensure they are ... (I/DD) services, long term services and supports, Unmet health-related resource needs, and Integrated care management . We...care management services is strongly preferred. + Case management certification is preferred. Please be… more
    Elevance Health (12/18/25)
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  • Director Care Management

    Providence (Fortuna, CA)
    …advancement. **Requsition ID:** 404781 **Company:** Providence Jobs **Job Category:** Care Management **Job Function:** Clinical Care **Job Schedule:** Full time ... innovative and strategic thinker with a dedication to excellence in healthcare management ? Do you excel in driving performance improvement and championing effective… more
    Providence (12/18/25)
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  • Utilization Management Specialist II

    AnMed Health (Anderson, SC)
    …necessity review, continued stay/concurrent review, retrospective review, bed status management , resource utilization management , regulatory compliance, ... + Uses clinical knowledge to independently review the medical record for clinical appropriateness and resource utilization including but not limited to :… more
    AnMed Health (11/13/25)
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  • Nurse Disease Management I

    Elevance Health (Las Vegas, NV)
    …community agencies and appropriate provider/network. + Refers member to catastrophic case management . **Minimum Requirement:** + Requires AS in nursing ... Skills, Capabilities and Experiences:** + BS in nursing preferred. + Prior case management experience preferred. + Experience in maternal health preferred.… more
    Elevance Health (12/18/25)
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  • Utilization Management Nurse

    US Tech Solutions (Hopewell, NJ)
    …duties and types of care management as assigned by management .** **Responsibilities:** 1. Assesses patient's clinical need against established guidelines ... services provided. 8. Encourages member participation and compliance in the case /disease management program efforts. 9. Documents accurately and comprehensively… more
    US Tech Solutions (10/24/25)
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  • Director, Utilization Management & Prior…

    Fallon Health (Worcester, MA)
    …of purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief Medical Officer will provide strategic leadership and ... Represents the Vice President and Senior Medical Director of Clinical Management at internal and external senior...Services as well as other departments by involving inpatient case management with out-patient case more
    Fallon Health (12/14/25)
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  • Care Manager

    Emory Healthcare/Emory University (Decatur, GA)
    …federal and state regulatory agencies. The CM will ensure proper use of Case Management Systems and workflows. Minimum qualifications: RN CM: MINIMUM REQUIRMENTS ... we fuel your professional journey with better benefits, valuable resources , ongoing mentorship and leadership programs for all types... Case Manager (ACM) Certification through the American Case Management Association or Certified Case more
    Emory Healthcare/Emory University (12/23/25)
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  • Transfer Center - RN/Registered Nurse - Full time

    Texas Health Resources (Arlington, TX)
    …* 4 Years experience as a registered nurse in critical care, emergency services, or case management Req or * 1 year transfer center experience within the last ... * Unique department where you get to use your clinical knowledge to help facilitate placing patients at appropriate...opportunities are only reflective of wholly owned Texas Health Resources entities. We are an Equal Opportunity Employer and… more
    Texas Health Resources (12/11/25)
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  • Nurse Navigator - Women's Health

    Rochester Regional Health (Rochester, NY)
    …regarding role of case management . This may include appropriate management of resources , discharge planning and complex medical/legal issues. + Assists ... for patients, including triage management , algorithm management , utilization management and resource management . Organizes services across the… more
    Rochester Regional Health (12/03/25)
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