- HealthTrust Workforce Solutions (Bradenton, FL)
- …access to more than 200,000 jobs nationwide. **_JOB SUMMARY_** The Interim Leader of Case Management Services is a Registered Nurse who participates as an ... management , cost control, contract compliance, quality improvement, utilization management , denials management and...that the following functions of the role are completed: Utilization Review for medical necessity of admission… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of First ... RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an...have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management … more
- US Tech Solutions (RI)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE… more
- Adecco US, Inc. (Tallahassee, FL)
- …Overview** A large acute care hospital is seeking an experienced ** Registered Nurse Case Manager** to join its Case Management team. This role focuses ... **Position Title:** Case Manager RN **Location:** Tallahassee, FL 32310 **Position Type:** Nursing...APRN license accepted if current and compliant + Case Management , Nursing, or Utilization Review … more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …a difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre ... performance and member satisfaction. Required Skills and Experience * Registered nurse or licensed behavioral health clinician...* 1+ years of managed care experience (eg case management , utilization management and/or auditing… more
- Kaleida Health (Buffalo, NY)
- …preferred. RN licensure required.** **Experience** **10 years of care management / utilization management experience required in hospital and/or ambulatory ... **VP Care Management Post-Acute Care Transition** **Location:** **Buffalo General Medical...daily oversight of operations, the VP will partner with Utilization Review , Revenue Cycle, and Clinical leadership… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …Coordination is responsible for system-wide Care Coordination functions ( Utilization Review , Social Work, Navigation, and Case Management ) including the ... A minimum of five years of experience in care management or utilization review +...Click here (https://www.aspirus.org/about) to learn more. Credentials: Essential: * REGISTERED NURSE LICENSE Position DIRECTOR - SYSTEM… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …true colors to blue. The Role:The Compliance Program Consultant will focus on utilization management compliance and audit readiness activities such as evaluating ... Medical Management 's (HMM) and delegate's compliance with the applicable NCQA utilization management standards and state and federal regulations. The Team:… more
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- …RN ) - Community Care, aligned under Chief of Staff. Responsibilities The Community Care (CC) RN Registered Nurse ( RN ) is responsible for executing a ... intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards,...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Nurse , Quality Review Utilization Management (UM) is to evaluate clinical quality and procedures ... within the Utilization Management (UM) program to maximize efficiency,...required work experience. **Licenses/Certifications Upon Hire Required:** + Health Services\ RN - Registered Nurse -… more