- AmeriHealth Caritas (Philadelphia, PA)
- …. **Responsibilities:** Under the supervision of the LTSS Manager/Director for Utilization Management , this position is responsible for providing daily ... Home Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and operational… more
- CenterWell (Marion, OH)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... **Position Type** : On-site **Branch Location** : Marion, OH **This is NOT a remote or work-from-home position. This position requires you to sit on-site at our… more
- CenterWell (Brooklyn Park, MN)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... Type** : On-site **Branch Location** : Brooklyn Park, MN **This is not a remote or work-from-home position. This position requires you to sit on-site at our**… more
- Nuvance Health (Danbury, CT)
- …in Milliman and InterQual Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum ... members of the interdisciplinary care team * Current working knowledge of utilization management , performance improvement and managed care reimbursement. Working… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …bilingual Spanish speaker * 1+ years of managed care experience; eg case management /health coach, utilization management and/or auditing experience. * ... across the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and… more
- ZOLL Medical Corporation (Boston, MA)
- …patients suffering from serious cardiopulmonary and respiratory conditions.ZOLL Cardiac Management Solutions offers a unique portfolio of novel technologies designed ... patients at risk of sudden cardiac death. + HFMS (https://cardiacdiagnostics.zoll.com/products/heart-failure-arrhythmia- management -system/) (Heart Failure Management system) is a… more
- Albany Medical Center (Albany, NY)
- …short- and long-term goals and objectives. As a member of the nursing executive management team, the AVP participates in the efficient and effective management ... Licensure, Certification & Registration: + Must hold a current NYS Registered Nurse license. Experience: + 7-10 years of experience in nursing, involving… more
- Actalent (Sacramento, CA)
- Remote Licensed Vocational Nurse (LVN) Fully...ICU) + At least 1 year of experience in utilization review, case management , or hospital discharge ... within 50 miles of the Sacramento area Job Duties + Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and discharges + Apply CMS… more
- CenterWell (Atlanta, GA)
- …of Operation:** Friday - Monday (5p - 8a) **Position Type** : Remote **Branch Location(s)** : Georgia **On-Call Expectation:** Participation in the weekend on-call ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
- Northwell Health (Melville, NY)
- … Review standard and regulations. + Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts ... + Inpatient clinical experience; 4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. + Must have experience… more