• Nurse Investigator

    State of Georgia (Fulton County, GA)
    Nurse Investigator Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/64040/other-jobs-matching/location-only) Hot ... Office of the Attorney General Georgia Department of Law Nurse Investigator- Medicaid Fraud Division *To move forward in...any blatant compliance issues. + Accurately documents findings from audit on standard forms. + Participates in interviews of… more
    State of Georgia (06/19/25)
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  • Nurse Case Manager Lead

    Elevance Health (Overland Park, KS)
    …with providers, claims or service issues + Assists with development of utilization /care management policies and procedures, chairs and schedules meetings, as well as ... and functions as preceptor for new care management staff + Participates in audit activities and assists supervisor with management of day-to-day activities, such as… more
    Elevance Health (07/25/25)
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  • Client Service Manager, Government

    GetWellNetwork, Inc. (Washington, DC)
    …Manager will take the Get Well program to the next level by driving nurse engagement, focusing on increased utilization , and leading projects of functionality to ... Facility. Get Well's Client Service Manager is responsible for effective product utilization and successful outcomes for the Get Well system at their designated… more
    GetWellNetwork, Inc. (06/29/25)
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  • Clinical Case Manager

    LifePoint Health (Rutherfordton, NC)
    …adaptation and outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of care and adherence ... all staff in UR standards and LOS topics. Insures effective Utilization Review Process.1. Performs admission and concurrent medical record review.2. Documents… more
    LifePoint Health (06/09/25)
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  • Manager, Healthcare Services (Nevada Health Plan)

    Molina Healthcare (Sparks, NV)
    …performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), case ... Collates and reports on Care Access and Monitoring statistics including plan utilization , staff productivity, cost effective utilization of services, management… more
    Molina Healthcare (07/25/25)
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  • LPN - MDS Coordinator

    Elderwood (Liverpool, NY)
    …$29.00 - $37.70 / hourly Overview Elderwood at Liverpool is seeking a Licensed Professional Nurse to join our clinical team as a LPN MDS Nurse Assessor. LPNs, ... right skill set, will be considered as well. MDS Nurse Assessor - Position Overview: + An MDS ...State requirements, and facility policies. + Actively participate in utilization management processes, including PDPM and state case mix… more
    Elderwood (07/25/25)
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  • RN, Case Manager (Part time), Forbes

    Highmark Health (Monroeville, PA)
    …relationships across the organization in a community setting. **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages ... that supports excellence of care and achievement of optimal resource utilization . Also facilitates appropriate LOS, patient satisfaction and reimbursement for all… more
    Highmark Health (05/13/25)
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  • MDS Coordinator

    Elderwood (Hamburg, NY)
    Salary Up to $49.50 / Hour Overview Elderwood at Hamburg is seeking a Registered Nurse (RN) to join our clinical team as a MDS Nurse . Position Overview: + An MDS ... (Minimum Data Set) nurse , or nurse assessment coordinator, collects and...State requirements, and facility policies. + Actively participate in utilization management processes, including PDPM and state case mix… more
    Elderwood (08/02/25)
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  • Manager, Care Integration Team

    CenterWell (Houston, TX)
    …managing populations and coordinating care to reduce acute and post-acute care utilization . The Manager role is hybrid with travel requirements to preferred ... Duties and Responsibilities** + Oversees day-to-day operations, quality chart audit reviews, recruiting/hiring, team management, and overall performance for Care… more
    CenterWell (06/13/25)
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  • Mental Health Program Manager I/Emergency…

    The County of Los Angeles (Los Angeles, CA)
    …goals. + Develops and implements reporting procedures to ensure that program services utilization and revenue data are reported accurately and in a timely manner. + ... review methods as necessary. + Oversees audits and the implementation of audit recommendations for programs managed. + Represents managed programs in meetings with… more
    The County of Los Angeles (08/02/25)
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