- UPMC (Pittsburgh, PA)
- …Nurse (RN) with an active PA License required + BSN Preferred + Case management nursing preferred. + Minimum 1 year of health insurance experience preferred. ... Nurse Clinical Care Coordinator is responsible for delivering nursing assessments and evaluations within recognized standards of ...+ 1 year of experience in clinical, utilization management , home care, discharge planning, and/or… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... and CMS criteria required + A minimum of three years of experience in utilization management , preferred + Team leading or management experience, preferred… more
- Sutter Health (Emeryville, CA)
- …Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to ... organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA will develop...of care such as Home Health, Hospice, Advance Illness Management (AIM), and Palliative Care. Skilled Nursing … more
- AdventHealth (Orlando, FL)
- …or Social Worker: BSW Masters in related field 3 years in direct Care Management / Utilization Management experience in an acute care setting **Preferred ... Debt-free Education (Certifications and Degrees without out-of-pocket tuition expense) + Nursing Clinical Ladder Program **Our promise to you:** Joining AdventHealth… more
- CVS Health (Oklahoma City, OK)
- …and timely discharge, appropriate follow-up care, and next steps. + Coordinate with the Utilization Management team to review medical and payer records to ensure ... stay and identify any barriers to discharge. + Assist Utilization Management team with access to external...+ Bilingual (English/Spanish) **Education** + Minimum Associates degree in Nursing or BH license + BSN preferred **Anticipated Weekly… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …the least restrictive, most cost-effective manner, through use of outpatient utilization management criteria, clinical practice guidelines and clinical pathways. ... reporting of consult trends and systems issues through the utilization of the nursing process. Responsible for...requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse… more
- AdventHealth (Palm Coast, FL)
- …+ Social Worker: BSW Masters in related field + 3 years in direct Care Management / Utilization Management experience in an acute care setting. + State ... Palm Coast, 32164 **The role you'll contribute:** The Care Management Manager is under the general leadership of the...specific RN license if a nurse . **Preferred qualification:** + Registered Nurse : BSN… more
- AdventHealth (Orlando, FL)
- …(manager level or above) in addition to 5 years of direct Care Management / Utilization Management experience and increasing leadership responsibility + RN-BC ... Rollins St, Orlando, FL 32803 **The role you'll contribute:** The Care Management Facility Director has full accountability and oversight for the overall operations… more
- AdventHealth (Daytona Beach, FL)
- …(manager level or above) in addition to 5 years of direct Care Management / Utilization Management experience and increasing leadership responsibility + RN-BC ... MEDICAL PKWY, Daytona Beach, 32117 **The role you'll contribute:** The Care Management Facility Director has full accountability and oversight for the overall… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …an Associate's Degree and a minimum of 2 years of experience in Utilization Management , Referral Management , Authorization/Denials, or Medical Claims ... Team Ivyhill is currently seeking to hire Referral Management (Non- Nurse ) Reviewers to support its contract with the Integrated Referral Management and… more