- University of Michigan (Ann Arbor, MI)
- …Pediatric Nurse Practitioner-Acute Care , Pediatric Nurse Practitioner-Primary Care (with 2 years of Pediatric Surgery RN /NP experience), Family ... + The Advanced Practice Professional will participate in patient care conferences and peer quality review with...Qualifications NP + Current licensure to practice as a Registered Nurse and Nurse Practitioner… more
- Datavant (Nashville, TN)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well...bring to the table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred +… more
- Elevance Health (FL)
- …disorder facility-based and outpatient professional treatment health benefits through telephonic or written review . The BH Care Manager ( UM ) job progression ... **JR169828 Behavioral Health Care Manager II** Responsible for managing psychiatric and...behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to… more
- Elevance Health (NC)
- **Behavioral Health Care Manager I - North Carolina (Day Shift)** **Location** **- Virtual:** This role enables associates to work virtually full-time, with the ... EST + Monday-Friday 9am-6pm EST + Monday-Friday 11am-8pm EST The **Behavioral Health Care Manager I - North Carolina (Day Shift)** is responsible for managing… more
- Elevance Health (Metairie, LA)
- …weekends and holidays as required by business needs. The **Behavioral Health Care Manager** **I** **-** **Louisiana** is responsible for managing psychiatric and ... facility-based and outpatient professional treatment health benefits through telephonic or written review . Primary duties may include but are not limited to: + Uses… more
- Brighton Health Plan Solutions, LLC (NC)
- …regulatory and accreditation requirements. * Duties as assigned. Essential Qualifications * Current Registered Nurse ( RN ) with state licensure. Must retain ... Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review ...URAC and NCQA. * 2+ years' experience in a UM team within managed care setting. *… more
- BronxCare Health System (Bronx, NY)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... appeals for the purpose of securing reimbursement for acute care services provided to patients. Assist in development of...submission in appeal. - In absence of Director, will review denial correspondence to determine validity of denial reason… more
- Highmark Health (Jackson, MS)
- …and/or triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established ... in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced...in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or… more
- San Antonio Behavioral Health (San Antonio, TX)
- …May consult with staff as needed. Essential Duties: + Collaborate and set standards with registered nurse ( RN ) case managers (CMs) and outcome managers to ... The Utilization Review Coordinator conducts utilization reviews to determine if...conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts… more
- CareFirst (Baltimore, MD)
- …programs such as Microsoft Word, Excel, Access, PowerPoint and Outlook. **Licenses/Certifications** : RN - Registered Nurse - State Licensure And/or Compact ... using adult learning principles. Uses instructional design principles to scope, review , modify, and redesign training materials to reflect current research and… more