- Molina Healthcare (North Las Vegas, NV)
- …Active, unrestricted Certified Case Manager (CCM) Some experience with Utilization Management processes is also desirable (InterQual, MCG guidelines) To ... members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness,… more
- Dignity Health (Long Beach, CA)
- …effectively with multiple stakeholders + Professional communication skills. + Understand how utilization management and case management programs integrate. + ... hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year...+ Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Proficient in application of… more
- Swedish Health Services (Seattle, WA)
- …strong clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. ... the state of Washington (WA) to be considered_** **Care Manager RN** **Per diem / On call** **Day shift**...CCM certification upon hire. + 1 year of Case management experience. **Why Join Providence?** Our best-in-class benefits are… more
- Trinity Health (Fort Lauderdale, FL)
- …acute hospital clinical experience is required.** Recent experience in case management , utilization review, discharge planning, ongoing monitoring and evaluation ... Plans to ensure authorization for hospital stay. Hybrid Position **_Position Purpose:_** ** Utilization Review (UR) Nurses play a vital role in healthcare by making… more
- Mount Sinai Health System (New York, NY)
- …Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring… more
- Prime Healthcare (Ontario, CA)
- …school of nursing and a current state Registered Nurse license. + Minimum 3 years RN Utilization Manager working for a Health Plan. + At least 3 years of ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/211752/ utilization -review-rn/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare… more
- Baptist Memorial (Memphis, TN)
- …safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer ... and/or life situation. Performs other duties as assigned. Responsibilities + Utilization Review + Discharge planning + Readmission Reduction Participation + Payer… more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding ... + Collaborates with the multidisciplinary team to assess and improve the denial management , documentation, and appeals process. + Collaborates with UR Manager … more
- Emory Healthcare/Emory University (Decatur, GA)
- …**Description** **8a-5:30p / Full Time / 36 hours** The **(RUN) Resource Utilization Rapid Response Critical Care, LTAC** is primarily responsible for supporting the ... and Code Blue. This indvidual: + May assist the emergency department in the management of critical care patients awaiting inpatient bed admission as well as EUHOP… more
- CVS Health (Annapolis, MD)
- …level. The Associate Manager is also responsible for oversight of utilization management nurses including the organization and development of high performing ... some rotational on-call holiday coverage as needed. The Associate Manager is accountable to support the day to day...compliance and privacy practices. + Oversees the implementation of utilization management services for assigned area +… more