- Centene Corporation (Chicago, IL)
- … (RN) with active Illinois license** + **Experience in case management and/or utilization review ** + **Previous work in an inpatient hospital environment is ... RN with a strong background in case management or utilization management within an inpatient setting? Join our dedicated...to develop appropriate care plans/service plans + May perform telephonic , digital, home and/or other site outreach to assess… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4 ... to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high risk pregnancy or… more
- Albany Medical Center (Albany, NY)
- …of America) Salary Range: $60,028.00 - $99,023.00 Salary range: $33/hr. - $47.60/hr. Registered Nurse (RN) - Full TimeHIV Medicine Clinic - Albany, NY We have an ... the practice physician and/or advanced practice provider (APP) and the supervision of the Nurse Manager (RN) and/or Nurse Supervisor (RN), the RN may provide… more
- UPMC (Pittsburgh, PA)
- …RN license. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to ... plan, paid time off, life insurance, and more! This is a primarily telephonic role with electronic responsibilities. While this role does work remotely, preference… more
- CareFirst (Baltimore, MD)
- …Utilizes MCG to act as a resource for the nurses to conduct concurrent review for medical necessity and appropriate level of care for Commercial and Government lines ... and manage health care costs. **We are looking for an experienced Registered Nurse and people leader with UM/CM experience** **living within the Washington DC and/or… more
- Albany Medical Center (Albany, NY)
- …Shift: Day (United States of America) Salary Range: $60,028.00 - $99,023.00 Registered Nurse (RN) - Full Time Pediatric Endocrine Department Monday to Friday: 8:00am ... the practice physician and/or advanced practice provider (APP) and the supervision of the Nurse Manager (RN) and/or Nurse Supervisor (RN), the RN may provide… more
- Intellatriage (Brentwood, TN)
- …clinical and non-clinical issues, managing communication, reducing unnecessary hospital utilization , and ensuring seamless coordination of care and closing gaps ... ease knowing their patients are in good hands. Our nurse triage services are in high demand, exceeding our.... Support new team members through structured training, call review , documentation coaching, and constructive feedback. . Conduct regular… more
- AmeriHealth Caritas (Southfield, MI)
- …plan of care, referrals, and evaluation of the effectiveness of the plan. + Review medication list and educate Members with pharmacy needs, and counsel on side ... ACFC electronic care management platforms where applicable. + Monitor appropriate utilization and coordinate services with other payer sources, make appropriate… more
- WMCHealth (West Nyack, NY)
- …needs assessment performed by the Care Manager through extensive medical record review , face to face and/or telephonic encounters with assigned patients ... begins palliative care consultations. . Develops and collects data; analyzes utilization of health care resources, including interpretation and application to case… more
- AmeriHealth Caritas (Southfield, MI)
- …plan of care, referrals, and evaluation of the effectiveness of the plan + Review medication list and educate Members with pharmacy needs, and counsel on side ... ACFC electronic care management platforms where applicable + Monitor appropriate utilization and coordinate services with other payer sources, make appropriate… more