- BronxCare Health System (Bronx, NY)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... purpose of reporting and implementing corrective measures. - Provide feedback to UM staff related to denial prevention strategies. - Participates in JCAHO hospital… more
- Community Health Systems (Bentonville, AR)
- …discharge planning by coordinating patient care activities under the supervision of a Registered Nurse or physician. This role involves reviewing medical records ... as needed to the Physician Advisor or Utilization Management ( UM ) committee. + Identifies avoidable hospital days and communicates...plans. **Licenses and Certifications** + LPN - Licensed Practical Nurse - State Licensure required + BCLS - Basic… more
- University of Michigan (Ann Arbor, MI)
- …above description. **Required Qualifications NP + Current licensure to practice as a Registered Nurse and Nurse Practitioner specialty certification in the ... Pediatric Nurse Practitioner-Primary Care (with 2 years of Pediatric Surgery RN /NP experience), Family Nurse Practitioner (with 2 years of Pediatric Surgery… more
- Centene Corporation (New York, NY)
- …and Certifications:** A license in one of the following is required: Licensed Registered Nurse ( RN ), Licensed Clinical Social Worker (LCSW), Licensed ... Clinical Social Work/Counseling required OR Associate's degree and an RN with 3+ years of clinical experience. 3+ years...or outpatient). 1+ year of experience in Managed Care ( UM , BH, CM) preferred. Familiarity with Medicare and Medicaid… more
- University of Michigan (Ann Arbor, MI)
- …privileging process. **Required Qualifications NP: + Current licensure to practice as a Registered Nurse and Nurse Practitioner specialty certification in ... Practitioner-Primary Care (with 2 years of Pediatric GI and/or Pediatric Nephrology RN /NP experience) or Family Nurse Practitioner (with 2 years of Pediatric… more
- US Tech Solutions (May, OK)
- …experience as an RN . 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization ... . MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1 YEAR OF UTILIZATION… more
- Actalent (Santa Barbara, CA)
- …Coordinator Job Description The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse assigned to one of several Health Services' operational units. ... methods. Additional Skills & Qualifications + Must have an active California Registered Nurse license + Experience within Utilization Management + Experience… more
- University of Michigan (Ann Arbor, MI)
- NURSE RECRUITER ( Nurse & PA Recruitment and Retention) Apply Now **Mission Statement** Michigan Medicine improves the health of patients, populations and ... savings **Responsibilities The University of Michigan Health (UMH), Michigan Medicine Nurse and PA Recruiter will be responsible for developing and executing… more
- UTMB Health (Webster, TX)
- …testing is also required. **_REQUIRED EDUCATION/EXPERIENCE_** **:** + Current Texas licensure as a Registered Nurse ( RN ).with a minimum of three (3) years ... AS 400. + Demonstrates skill in accurately entering required UM data. + Monitors and facilitates appropriate utilization of...transfers and admissions from the prison facility. + Conducts nurse to nurse conference calls for all… more
- Humana (Tallahassee, FL)
- …providers or members **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in either Florida or a compact state ... community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care...GA + 2 or more years of Utilization Management ( UM ), Pre-Auth, and/or other managed care review experience +… more