- Hartford HealthCare (Willimantic, CT)
- …**Windham Hospital* **Title:** * Registered Nurse Case Manager ( RN ) - Utilization Management * **Location:** *Connecticut-Willimantic-Windham Community ... clinical nursing required. * Two years experience with case management , discharge planning, utilization review ... experience preferred. *LICENSURE/CERTIFICATION* * Current license as a registered nurse in the State of Connecticut.… more
- AnMed Health (Anderson, SC)
- …, continued stay/concurrent review , retrospective review , bed status management , resource utilization management , regulatory compliance, and related ... issues. Duties & Responsibilities + Performs assigned utilization management functions daily: initial, concurrent and retrospective review of the… more
- Humana (Jackson, MS)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- CVS Health (Baton Rouge, LA)
- …we do it all with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for Prior Authorization conducts ... improvement, policy review , and education related to utilization management . * Serve as a clinical...and data integrity **Required Qualifications** * Active, unrestricted Louisiana RN license or compact license * Minimum 3 years… more
- UCLA Health (Los Angeles, CA)
- …+ experience in an HMO environment + Thorough knowledge of health care industry, utilization review , utilization management , and concurrent review ... at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management...following major functions: + Pre-service Authorizations/Denial Letters + Concurrent Review + Continuity of Care + Retro Claims +… more
- CVS Health (Baton Rouge, LA)
- …each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for NICU Concurrent Review conducts high-acuity, timely, and ... integrity and compliance. * Participate in quality improvement, policy review , and education related to NICU and special populations..., and education related to NICU and special populations utilization management . * Serve as a clinical… more
- CareFirst (Baltimore, MD)
- …in addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact ... **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination… more
- Prime Healthcare (Inglewood, CA)
- …provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and ... Workers, and Clinical Coordinators. This leader will oversee all facets of utilization management , discharge planning, and care coordination to ensure patients… more
- Penn Medicine (Lancaster, PA)
- …6:30am-9am. No holidays _Penn Medicine Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this ... we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible...assigned. **Minimum Required Qualifications:** + Current licensure as a Registered Nurse , issued by the Pennsylvania Board… more
- CVS Health (Phoenix, AZ)
- …that promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. ... partial hospitalization and intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior… more