- Houston Methodist (The Woodlands, TX)
- …and eligibility for state, local, and federal programs + Progressive knowledge of utilization management , case management , performance improvement, and ... At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a...coverage determinations (LCDs & NCDs). This position collaborates with case management in the development and implementation… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... in standard medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care. + Knowledge of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as ... depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of… more
- Humana (Frankfort, KY)
- …Qualifications** + Bachelor's degree in nursing (BSN) + Previous experience in discharge planning, utilization management or case management a plus + ... a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Veterans Affairs, Veterans Health Administration (Augusta, GA)
- Summary The Nurse Utilization Management (UM) Registered Nurse (RN) is responsible for providing competent, evidence-based practices within the position. Uses UM ... observation, admission, and continued stay patients. Responsibilities The Nurse Utilization Management (UM) Registered Nurse (RN) is...(may be extended up to two years on a case -by- case -basis.) NOTE: Grandfathering Provision - All persons… more
- Florida Health Care Plans, Inc. (Daytona Beach, FL)
- … within the community to various locations. POSITION SUMMARY: As part of the Utilization Management division, the social worker will intervene with members who ... order to fully engage with members and their families, travel to hospitals, rehab or skilled nursing facilities and...relationships with FHCP colleagues and external vendors in providing case management services is essential to the… more
- CVS Health (Boise, ID)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... each and every day. **Schedule is Monday - Friday 8am-5pm est.** No travel required. Non-exempt. Hourly. Pay: Bi-weekly. No shift premium. Occasional Overtime may be… more
- Guthrie (Binghamton, NY)
- …clinical approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the ... , utilization review, and payer knowledge. A Case Management certification or obtaining a ...as necessary in the performance of this position. + Travel for this position is sometimes required. + Participation… more
- UNC Health Care (Raleigh, NC)
- …continuity of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The Care ... **Description** **Our Case Management team is seeking a...Refer administrative tasks (eg, faxing, form processing) to Care Management Assistant. Consult Social Worker and/or Utilization … more
- Amergis (French Camp, CA)
- …+ Current RN licensure in state practicing + At least one year of Case Management experience preferred + Current CPR if applicable + TB questionnaire, ... **Local Pay $75/hr** - No stipend pay The RN Case Manager is responsible for coordinatingcontinuum of care activities...week RNs will be doing denials, discharge planning, and utilization review Hiring points for a perfect candidate: Current… more