• Outpatient Mental Health Clinic-Registered…

    Veterans Affairs, Veterans Health Administration (Aurora, CO)
    Summary This is an OPEN-CONTINOUS ANNOUNCEMENT. The Outpatient Mental Health Registered Nurse is responsible and accountable for all elements of the nursing process ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsibilities… more
    Veterans Affairs, Veterans Health Administration (05/07/25)
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  • Manager, Healthcare Services ( Remote

    Molina Healthcare (Worcester, MA)
    …performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... **JOB DESCRIPTION** **Job Summary** **This position will offer remote work flexibility but the hired candidate must...years in one or more of the following areas: utilization management , case management , care… more
    Molina Healthcare (06/01/25)
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  • Registered Nurse -Transition to Practice…

    Veterans Affairs, Veterans Health Administration (Columbus, OH)
    …in an open position as determined by Nursing Leadership. The new graduate registered nurse (RN) interprets the philosophy and goals of nursing service to others in ... managing complex patient situations (VA Handbook 5005, Part II, Appendix G6). registered nurse is a competent nurse who demonstrates competence in practice and… more
    Veterans Affairs, Veterans Health Administration (07/16/25)
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  • Registered Nurse - Only for Current…

    Veterans Affairs, Veterans Health Administration (Amarillo, TX)
    …this announcement must update their applications every 90 days. As the Registered Nurse , you will use professional standards of care and practice to evaluate self, ... others in research activities to improve care. Identify and assess resource utilization and safety issues, taking appropriate action. Work Schedule: Varies based on… more
    Veterans Affairs, Veterans Health Administration (05/01/25)
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  • Inpatient Nurse Care Manager

    Children's Mercy Kansas City (Kansas City, MO)
    …from admission to discharge including ancillary services, physicians, pharmacy, and care management . This role requires that the Nurse Care Manager uses ... to promote safe, optimal, cost-efficient and satisfying patient/family outcomes. The Nurse Care Manager job functions include coordination of services for identified… more
    Children's Mercy Kansas City (06/18/25)
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  • Registered Nurse - Call Center, Poison…

    SSM Health (St. Louis, MO)
    …MO-SSM Health Integrated Health Technologies **Worker Type:** Regular **Job Highlights:** Note:** Remote work is not available until after two years, along with ... Referral Bonus available to current employees Responsible for emergency telephone management of poisoning exposures and questions handled by the Missouri Poison… more
    SSM Health (07/24/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Midvale, UT)
    …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... _For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and… more
    Molina Healthcare (07/20/25)
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  • Clinical Reviewer III (ECSS), Remote in

    Magellan Health Services (Baton Rouge, LA)
    management and verbal and written communication skills. Knowledge of utilization management procedures, Medicaid benefits, community resources and providers. ... care setting. Also requires minimum of 4 years of experience conducting utilization management according to medical necessity criteria. General Job Information… more
    Magellan Health Services (06/25/25)
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  • Clinical Appeals Nurse Reviewer

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …member and provider submitted appeals. Working collaboratively with Physician review unit, Utilization Management , Case Management , Member appeals and ... your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound clinical judgement...Grievance, Provider Service, Claims, Network Management , and Medical Policy teams. This role is eligible… more
    Blue Cross Blue Shield of Massachusetts (06/26/25)
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  • Workers Compensation Support Registered…

    AdventHealth (Altamonte Springs, FL)
    …Support Registered Nurse is responsible for providing telephonic medical case management for Workers Compensation Injury cases. Case Management is a ... youll bring to the team:** + Provide telephonic case management for multi-state claim caseload assignment (excluding GA: written...written consent required, and NC: must be registered rehab nurse with NCIC) + Reports directly to the WC… more
    AdventHealth (07/22/25)
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