- Saint Francis Health System (Tulsa, OK)
- …in various levels of care and receipt of necessary services. The Utilization Management ( UM ) Registered Nurse will communicate with providers the details of ... Nursing. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 2 years of… more
- Molina Healthcare (San Antonio, TX)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Austin, TX)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services are… more
- Corewell Health (Royal Oak, MI)
- …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
- Whidbey General Hospital (Coupeville, WA)
- JOB SUMMARY Are you a flexible, self-motivated RN who thrives in a collaborative, fast-paced environment? At WhidbeyHealth, our Care Managers play a vital role in ... at the right time-we'd love to meet you! The RN - Care Manager is a health care professional...Manager will lead an assessment to identify the patient's clinical needs to be accommodated and constructs a care… more
- University of Michigan (Ann Arbor, MI)
- RN CASE MANAGER: University Hospital (Care Management) Apply Now **Job Summary** The RN Case Manager assesses, develops, implements, coordinates and monitors a ... care areas. The position is unique in that it combines clinical /quality considerations with regulatory/financial/utilization review demands. The position creates a… more
- UnityPoint Health (Cedar Rapids, IA)
- …care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to BH ... with physicians, third party payers and regulatory agencies. The UM spcialist will also be called upon to provide... spcialist will also be called upon to provide clinical and nursing expertise and support within the HOD… more
- Nuvance Health (Danbury, CT)
- …or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience in an acute care setting * ... for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering...ensure CMS and regulatory compliance.* *Develop and maintain a UM plan to guide the team with detailed processes… more
- Saint Francis Health System (Tulsa, OK)
- …field. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), ... through Friday, 8:00 am to 5:00 pm** Job Summary: Provides administrative and clinical support to the hospital and treatment team throughout the review of patients,… more
- Alameda Health System (Oakland, CA)
- …nursing background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Preferred ... of quality improvement initiatives. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals .… more