- Hawaii Pacific Health (Lihue, HI)
- …long term care, or related field. **Preferred Qualifications:** Current Case Management or Utilization Management certification. \#Bonus1 ... and programs, including cardiology, emergency, family practice, gastroenterology, health management , internal medicine, neurology, OB-GYN, oncology, orthopedics, pediatrics and… more
- Sutter Health (Roseville, CA)
- …Sutter Health philosophies and initiatives. Participates as a member of the utilization Management Committee (UMC). **Job Shift:** Days **Schedule:** Full Time ... well as patients and their families. **Job Description** : **EDUCATION:** + Master's: Nursing , Case Management , or Social Work **CERTIFICATION & LICENSURE:** +… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …, utilization management and/or auditing experience). * Bachelors degree in nursing . * Certification in utilization management or a related field. * ... difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre and… more
- Highmark Health (Washington, DC)
- … **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Geisinger (Wilkes-Barre, PA)
- …and efficiency results for assigned population. + Works to appropriately apply benefits and utilization management serving as a resource to the patient or member ... Case Managers - and are dedicated to elevating your nursing career. Our culture empowers you to act with...have prior RN experience in a hospital setting. Case Management experience is preferred and not required. The successful… more
- Sutter Health (Jackson, CA)
- …Health! **Organization:** SAH-Sutter Amador Hospital **Position Overview:** Coordinates the utilization management , resource management , discharge planning, ... needs. **Job Description** : **EDUCATION:** + Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California +… more
- Nuvance Health (Danbury, CT)
- …experience required with at least 2 years relevant experience in denials, case or utilization management required. * 5 years management experience preferred ... the direct oversight of daily operations of clinical denial prevention and Utilization Review (UR) activities, including daily collaboration with physicians as well… more
- Centene Corporation (New York, NY)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **This is a fully remote… more
- Centene Corporation (Phoenix, AZ)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Nuvance Health (Poughkeepsie, NY)
- …case from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within ... - Discharge Planning primarily Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support the… more