- AmeriHealth Caritas Health Plan (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... occasional overtime, and weekends based on business needs Responsibilities Conduct utilization management reviews by assessing medical necessity, appropriateness… more
- NORTH EAST MEDICAL SERVICES (Burlingame, CA)
- …CA Salary Range $128752.00 - $165048.00 Salary Description SUMMARY OF POSITION: The Utilization Management (UM) Nurse is a licensed nursing professional ... Nurse will also work with the MSO Case Management team on coordinating patient care to ensure patients...to solve the complex issues. Collaborates with MSO Case Management team and PCPs to ensure resource utilization… more
- Guidehealth (Philadelphia, PA)
- …Based clinical initiatives. This includes but is not limited to case management , transitions of care, care coordination and continuity, provider/staff education on ... maintain a network of community support. This individual must exhibit strong leadership, management , and interpersonal skills, as well as the ability to utilize both… more
- Mindful Care (New York, NY)
- We are seeking Board Certified Psychiatric Mental Health Nurse Practitioners (PMHNP) to expand access to behavioral health care in your area. If you're passionate ... control over their schedule. We handle patient scheduling, prior authorizations, case management , billing, and other support functions. Our efficiency enables us to… more
- Veterans Health Administration (Phoenix, AZ)
- …promotion, health education and coaching on wellness, disease prevention, and chronic care management . The nurse will assist in directing the provision of ... responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Administers… more
- Pair Team (Livermore, CA)
- …of whole-health care that Pair Team can provide. This position primarily allows for remote work; however, it includes 1-2 times a month on-site visits in the ... home What You'll Do Maintain ongoing caseload of individuals through the utilization of evidence based approaches to promote engagement and achievement of health… more
- Mass General Brigham (Salem, MA)
- …contact Deb Dingley, ###@mgb.org to learn more. Job Summary Summary The Registered Nurse manages all aspects of the nursing process and the delivery of patient ... and family centered care. The Registered Nurse has the responsibility and authority to request and...Specialist and Health Care Coordinator for complex patient care management and discharge planning. -Identifies barriers to implementing the… more
- Sentara Healthcare (Norfolk, VA)
- …support those in hospital patients identified in need of comprehensive case management . Promotes effective utilization and monitoring of health services, ... 1 year acute care case management preferred keywords: Inpatient Case Management , Registered Nurse , RN, Social Work, Discharge Planning, Nursing-Case … more
- Veterans Health Administration (Indianapolis, IN)
- Summary Inpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based care to assigned patients and oversight of licensed vocational ... a comprehensive total rewards package: https://vacareers.va.gov/wp-content/uploads/sites/5/2025-Total-Rewards-RN-NP-CRNA-VA-Career.pdf Inpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based care… more
- UnitedHealth Group (Minneapolis, MN)
- …concurrent and/or retrospective overpayment identification audits Experience working with Utilization Management Experience with readmission reviews of claims ... base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our… more
