- Humana (Lansing, MI)
- …part of our caring community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and independent ... best and most appropriate treatment, care, or services for Enrollees. The Utilization Management Nurse Lead coordinates and communicates with Providers,… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... resource to the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs & NCDs). This 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 team ... frontline staff. Salary: $75,000.00/Annually JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse Team Lead's responsibilities include but are not limited to:… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support staff from ... onboardings with time sensitive requirements. + Support and grow the utilization management team through strong professional relationships, mentorship, modelling of… more
- Sharp HealthCare (San Diego, CA)
- …Degree in Nursing; Bachelor's Degree in Nursing; Master's Degree; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Case Manager (CCM) ... acute care or clinical experience in area of specialty. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred Qualifications** + Master's… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) responsible for promoting the ... an expert level at all objectives delineated in the Utilization Review Nurse and Utilization ...concern that may require clinical review during the pre-bill, audit , or appeal process. **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Expands… more
- LifePoint Health (Hickory, NC)
- *_Registered Nurse (RN), Clinical Case Manager PRN_* *_PRN/Days_* * * * * *Schedule:* Monday-Friday 7:30a-4:00p/8:00a-4:30p * *Your experience matters* Frye Regional ... can provide exceptional care to others. As a Registered Nurse (RN)**joining our team, you're embracing a vital mission...outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of… more
- LifePoint Health (Hickory, NC)
- *_Registered Nurse (RN), Clinical Case Manager PRN_* *_PRN days_* ** ** *Schedule:* Monday-Friday 7:30a-4:00p/8:00a-4:30p * *Your experience matters* Frye Regional ... can provide exceptional care to others. As a Registered Nurse (RN)**joining our team, you are embracing a vital...outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of… more
- STG International (Milledgeville, GA)
- STGi is seeking a Licensed Practical Nurse /Licensed Vocational Nurse to provide services to our Georgia War Veterans Home. JOB SUMMARY: The primary purpose of ... FUNCTIONS: + Ensure the facility meets the minimum staffing levels for nurses and nurse aides; complete required posting of nursing staff data as required. + Ensure… more
- Beth Israel Lahey Health (Cambridge, MA)
- …with Harvard Medical School. The Inpatient Case Manager (CM) performs utilization reviews and coordinates discharge planning for MAH inpatient admissions. Inpatient ... performance is evaluated using the Inpatient Case Manager Guidelines and audit tool. Reports to Inpatient Case Management Supervisor. **Job Description:** **Primary… more