- Molina Healthcare (Davenport, IA)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Providence (Olympia, WA)
- …Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review, discharge planning, documentation ... Inpatient setting + IRR or annual competency testing in Utilization Review **Preferred qualifications:** + Bachelor's Degree Nursing...area of specialty. + 1 year experience in care management or utilization review in any setting… more
- Actalent (Portland, OR)
- …+ Knowledge of Medicare and Medicaid regulations preferred. + Familiarity with utilization management processes. + Previous experience with prior authorization ... + Collect, document, and maintain all members' clinical information in health management systems to ensure compliance with regulatory guidelines. + Provide education… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... nurse (RN) responsible for comprehensively planning for case management of a targeted patient population on a designated...nursing experience which includes two years in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN -… more
- Charter Care Health Partners (Providence, RI)
- …and Utilization Review Coordinator is responsible for bed management , reviewing intake assessments, verifying clinical appropriateness for services, coordinating ... admissions, and overseeing utilization review activities to ensure timely access to care...between patients, providers, and insurance carriers. Education: Bachelor's degree Nursing required. Master's degree preferred. Experience: Minimum 2-3 years… more
- Trinity Health (Fresno, CA)
- …the acute care continuum for CVHP members. This includes discharge planning, utilization management , care coordination, and support for resource utilization ... an interdisciplinary team to improve patient care through the effective utilization of the facility's resources. The incumbent makes significant contributions toward… more
- Trinity Health (Fresno, CA)
- …populations across the acute care continuum. This includes discharge planning, utilization management , care coordination collaboration, and support for resource ... with an interdisciplinary team to improve patient care through the effective utilization of the facility's resources. 1. Current licensure as a Registered … more
- CVS Health (Oklahoma City, OK)
- …Oklahoma RN licensure **Preferred Qualifications:** + Prior Authorization Experience + Utilization Management Experience + Managed Care experience preferred ... for referrals and program integration. Promotes quality and effective benefit utilization , consults with internal and external stakeholders, and meets productivity… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient… more
- Whidbey General Hospital (Coupeville, WA)
- …, anti-biotic regime, etc. The RN - Care Manager follows the hospital's Case Management / Utilization Plan that integrates the functions of utilization review, ... in the areas of utilization review, status determination, clinical resource utilization , the discharge planning and appeal/denial management . The RN - Care… more