- Hartford HealthCare (Manchester, CT)
- …timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and ... responsible for preoperative, concurrent, and retrospective reviews in accordance with the utilization management plan. The UM CM ensures the appropriate status… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- Jennie Stuart Health is seeking a dedicated Case Management Nurse to join our healthcare team on a PRN basis. This role is integral to our patient care system, ... psychosocial support throughout the continuum of care. The Case Management Nurse will be based at our...teamwork + Experience with InterQual criteria + Understanding of utilization management + Knowledge of CMS regulations… more
- Banner Health (AZ)
- …pre-service requests, provide case management , care coordination and perform utilization management duties within the appropriate time period as outlined ... health Plan consumer/beneficiaries' and providers with issues related to prior authorization, utilization management , and/or case management . Meets internal… more
- ERP International (Luke AFB, AZ)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... **Overview** ERP International is seeking a full time **Registered Nurse - Case Management ** in support of the56th Medical Group at Luke AFB, AZ… more
- WellSpan Health (York, PA)
- …**Essential Functions:** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for continued ... quality and cost of care efforts. + Liaisons between utilization management team, third party payers, and...or Clinical Nursing Specialty. Preferred **Licenses:** + Licensed Registered Nurse Upon Hire Required or + Registered Nurse… more
- WellSpan Health (Lebanon, PA)
- …**Duties and Responsibilities** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for continued ... quality and cost of care efforts. + Liaisons between utilization management team, third party payers, and...or Clinical Nursing Specialty. Preferred **Licenses:** + Licensed Registered Nurse Upon Hire Required or + Registered Nurse… more
- CVS Health (Springfield, IL)
- …Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management , Community Resources ... team will review prior claims to address potential impact on current case management and eligibility status. Assessments and/or questionnaires are designed to use a… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition ... Registered Nurse (RN) - Case Manager - 2506003285 Description...q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Case Management . + Determines appropriate care level and resource utilization for complex cases. + Facilitates discharge planning and evaluates alternative ... educator, Pediatric Nursing, Gerontological Nursing, Maternity Nursing, Population health, Disease Management . + Current licensed Registered Nurse (RN) with… more
- Ventura County (Ventura, CA)
- …Inpatient Psychiatric unit of the Ventura County Medical Center including utilization management , transfer coordination, discharge planning, and securing ... CANDIDATE The ideal candidate is an experienced Mental Health Nurse with a background in utilization review...and review; + Performs daily clinical reviews to support utilization and quality management , ensuring compliance with… more