- Actalent (Atlanta, GA)
- …(Rotating weekends) About the Role We are seeking a detail-oriented and compassionate Utilization Review Registered Nurse ( RN ) to join our team. In ... Job Title: Utilization Review RN Location:...providers, members, and internal teams (claims, benefits, appeals, risk management ). Required Qualifications + Active RN license… more
- MTC (Graceville, FL)
- …medical team who are dedicated to improving people's lives. We are seeking an **On-Call Registered Nurse ( RN )** to join our team. **Primary duties:** + ... forms as appropriate. + Practice basic cost containment and utilization management for inmate care and facility...HIPAA rules. + Accurately and promptly chart medical care. Review medical files to determine all provided services are… more
- UNC Health Care (Raleigh, NC)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The Care Manager ... Management Team is seeking an experienced full time RN Care Manager for Emergency Department patients. This role...date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North… more
- FlexStaff (Lake Success, NY)
- **Req Number** 177188 Registered Nurse Case Manager - FlexStaff Serves as liaison between the patient and facility/physician. Ensures a continuum of quality ... + Facilitates patient management throughout hospitalization + Performs concurrent utilization management using evidence based medical necessity criteria +… more
- HCA Healthcare (Tallahassee, FL)
- …is acceptable for position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review , preferred** + **Three years ... and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party… 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 (Columbia, SC)
- …the continuum of care. Responsibilities The Community Care Nurse (CC) Coordinator Registered Nurse ( RN ) is responsible for executing a streamlined ... 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
- HCA Healthcare (Tallahassee, FL)
- …active FL RN licenserequiredwithin90 days of hire** + **Advanced Practice Registered Nurse license is acceptable for position if current and compliant** ... medical necessity, admission status, level of care, and resource management . The RN CM Care Coordinator will...+ **Certification in Case Management , Nursing, or Utilization Review ,… more
- HCA Healthcare (Tallahassee, FL)
- …is acceptable for position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review , preferred** + **Three years ... and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party… more
- CVS Health (Austin, TX)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... and can include either a 30 or 60 min unpaid lunch.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating all… more