- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds...background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director , Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical ... with time sensitive requirements. + Support and grow the utilization management team through strong professional relationships,...Essential Qualifications + Active and unrestricted license as a Registered Nurse ( RN ). + Bachelor's… more
- Tufts Medicine (Burlington, MA)
- …in Nursing (BSN). 2.Massachusetts RN Licensure. 3. Current certification in case/ utilization management (ACM, CCM, CMAC) 4. Seven (7) years of UM/Case ... review and management . The position develops and leads the Utilization Management operations, strategy and implementation of the Utilization … more
- Monte Nido (Miami, FL)
- …decrease peer to peer reviews. + Communicate emerging trends with insurance companies to Director of Utilization Management . + Maintain database of insurance ... providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been delivering… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse ( RN )** for a full-time position supporting the 2d Medical ... and other health team members. Submits all concerns through Utilization Management Director ; be able...Management is required. Full time employment as a registered nurse within the last 36 months… more
- Commonwealth Care Alliance (Boston, MA)
- 011200 CCA-Central Clin Ops Leadership **Position Summary:** Reporting to the Sr. Medical Director of Utilization Management (UM) and Policy, the Medical ... to the population serviced by CCA. The Medical Policy Director is an independent contributor who works in partnership...have):** + 10 years of experience in medical policy, utilization management , clinical program leadership within a… more
- Humana (Lansing, MI)
- …. + Collaborate with the Chief Medical Officer, Quality Improvement Director , Utilization Director , Population Health Management Director and ... National Medicaid LTSS Care Management Director to oversee the processing of LTSS ...work environment. **Preferred Qualifications** + Master's Degree. + Licensed RN or Licensed Social Worker in the State of… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …And more **Description** The ** Utilization Review (UR) Specialist** is a Registered Nurse responsible for conducting thorough medical necessity reviews to ... extended recovery admissions as required based on Emory Healthcare's Utilization Management Plan and the UR Department...review experience. + Must have a valid, active unencumbered Registered Nurse license approved by the Georgia… more
- Select Medical (Los Angeles, CA)
- …Multiple Traumas Apply for this job (https://jobs-selectmedicalcorp.icims.com/jobs/340435/ director -of-case- management -%28registered- nurse %2c- rn ... hospitalization for their recovery. We are currently seeking a ** Director of Case Management - RN...to build consensus among multiple disciplines. **Qualifications** **Qualifications** + Registered Nurse ( RN ) or Licensed… more