- LA Care Health Plan (Los Angeles, CA)
- Supervisor , Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is...player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Hackensack Meridian Health (Brick, NJ)
- …a leader of positive change. The role of ** Supervisor , Care Management ** integrates and coordinates utilization management , care coordination, discharge ... Microsoft Office and/or Google Suite platforms. **Lice** **nses and Certifications Required:** + Registered Nurse ( RN ) with current New Jersey (NJ) License,… more
- Centene Corporation (Columbus, OH)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... IN STATE OF OHIO IDEAL CANDIDATE WILL HAVE PRIOR AUTHORIZAION OR UTILIZATION MANAGEMENT EXPERIENCE PEOPLE LEADER EXPERIENCE STRONGLY PREFERRED **Position… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures ... internal partners (eg, Provider Relations, Quality) to resolve escalations and address utilization management issues. + Represent UM nursing team in internal… more
- Molina Healthcare (NM)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- AmeriHealth Caritas (Lafayette, LA)
- …Under the direction of the Supervisor , the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity ... to 2 weekends per year. **Education & Experience:** + Registered Nurse candidates: Associate Degree in Nursing...and American Society of Addiction Medicine (ASAM) criterion. + Utilization management experience within a managed care… more
- AmeriHealth Caritas (Washington, DC)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Bon Secours Mercy Health (Portsmouth, VA)
- …Advanced Cardiac Life Support acceptable in lieu of BLS) Medical-Surgical Nursing Certification RN -BC ( Registered Nurse - Board Certified) (preferred) CCRN ... ( RN ) - Med-Surg - Maryview Medical Center_** **Job Summary:** The Med-Surg Registered Nurse ( RN ) position is responsible for delivering exceptional… more
- Bon Secours Mercy Health (Greenville, SC)
- …and operational excellence. FT Nights **Summary of Primary Functions** The Critical Care Registered Nurse ( RN ) provides, coordinates, plans, and evaluates ... Nurse (preferred) PCCN Progressive Care Certified Nurse (preferred) RN -BC Registered Nurse - Board Certified (preferred) TCRN Trauma Certified… more
- Good Samaritan (Inver Grove Heights, MN)
- …schedule with a weekend on-call rotation shared with the other supervisory staff. MN Registered Nurse , RN required. Prior MDS experience preferred. **Job ... week MDS Coordinator will be a part of our management team. Primary responsibilities will be MDS duties for...Summary** The RN Case Manager, Long Term Care (LTC) assesses, implements,… more
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