- Sharp HealthCare (La Mesa, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA...Cycle/HIM regarding RAC decision to appeal, denials, input into appeals , share findings with providers. Review all cases… more
- St. Peters Health (Helena, MT)
- The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR team ... members in providing all identified utilization review functions for the organization to ensure cost effective...the patient/family, physicians, and the interdisciplinary team, the UR RN ensures the care delivery systems at SPH are… more
- Saint Francis Health System (OK)
- …levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the details of reimbursement ... support to the hospital and treatment teams throughout the review of patients including, but not limited to their...Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 2… more
- Corewell Health (Royal Oak, MI)
- …in care management, utilization review , home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon Hire ... Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. Responsible for managing… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …transform healthcare? Bring your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the credentialed practitioner/ ... Team:As an integral part of the Credentialing & Peer Review (CPR) Team, the Peer Review Specialist...Team + Legal Department: + Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare Advantage, and InterPlan Program)… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages ... and outcomes. Interviews and collects patient specified data and chart review related to readmission. + Knowledgeable of and complies with accreditation… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …care coordination, and transition of care between settings. Required Skills and Experience * Registered nurse with current MN license and with no restrictions. * ... Cross and Blue Shield of Minnesota Position Title: Care Advocacy Case Manager RN - Bilingual Spanish Location: Remote Career Area: Health Services About Blue Cross… more
- Catholic Health Services (West Islip, NY)
- …degree required. + Master of Science degree strongly preferred. + Licensure: New York Registered Nurse ( RN ) License & Registration. + Certification: Care ... not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure… more
- UnityPoint Health (Cedar Rapids, IA)
- …with thrird party payers regarding authorization of stay, continued stay reviews, appeals and denial letters. + Provides education and serves as a resource ... self-management and health care decision-making. Qualifications + State of Iowa Licensed RN + Two years of behavioral health work experience. + Professional… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** RN /Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management for an assigned ... experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager...or a minimum of 3-5 years experience as a RN in an acute care setting. Licensing and Certification… more