- HCA Healthcare (Houston, TX)
- …and other third-party payers in accordance with procedures set forth in the Hospital Utilization Management Plan and the criteria and standards approved by the ... any other healthcare provider. We are seeking a(an) Registered Nurse Case Manager to join our healthcare family. **Benefits**...extended stays in accordance with criteria approved by the Utilization Management Committee and Medical Staff with… more
- NJM Insurance (Parsippany, NJ)
- …years of prior experience in clinical nursing (Med-Surg or Critical Care preferred), Utilization Management Review /Hospital concurrent reviews, and/or Case ... comply with all statutory, regulatory, licensing requirements, and NJM policies/guidelines that affect utilization review and medical management work. + Stay… more
- Veterans Affairs, Veterans Health Administration (Sioux Falls, SD)
- …for admission and continued stays. Lead process improvements related to inpatient utilization review activities. VA offers a comprehensive total rewards package: ... 24/7 house-wide nursing leadership. This role is responsible for daily staffing, resource management , and serving as a backup Registered Nurse (RN). Key duties… more
- Crouse Hospital (Syracuse, NY)
- …day management of the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals functions. + Assessing ... Manager who is responsible for providing day to day management of the RN Care Managers in the department....acute care discharge planning + Preferred - Acute care utilization review experience Benefits Overview: + Medical,… more
- LifePoint Health (Johnstown, PA)
- …care of hospitalized patients. Our team of RN Case Managers, Social Workers, Utilization Review staff, and Discharge Planners assure that payer requirements are ... harassment in employment. **Job:** **Nursing* **Organization:** ** **Title:** *Registered Nurse (RN)- Case Management PRN/Hourly* **Location:** *Pennsylvania-Johnstown*… more
- The Cigna Group (Peoria, AZ)
- **Summary** The Nurse Case Management Lead Analyst is an integral member of the Care Management department as part of Evernorth Care Group (ENCG) primary ... of high- and rising-risk, disease burdened members. The Nurse Case Management Lead Analyst utilizes clinical...eligible programs within ENCG and respective Arizona health plans. Review and inform the patient/caregiver around options for care,… more
- UPMC (Pittsburgh, PA)
- …of health insurance experience preferred. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... clinical and social history, current medications, geriatric syndromes, healthcare resource utilization , and case management interventions. Updates the plan of… more
- Henry Ford Health System (Detroit, MI)
- …+ Proficiency with computers, electronic health records (EHR), database systems, and utilization review /case management documentation systems. + Knowledge of ... bonus available for qualified experienced candidates with current 2 years RN Case Management in a large acute care hospital setting. GENERAL SUMMARY: The Case… more
- Veterans Affairs, Veterans Health Administration (MO)
- …education, orientation, competencies and providing quality improvement and enhance outcomes utilization . The nurse demonstrates competence in practice and ... the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible...ensure documentation is accurate and reflective of the Resource Utilization Group (RUG) score. The CLC Nurse … more
- AdventHealth (Land O' Lakes, FL)
- …for one another and respect for each person's unique contributions, provides utilization review care that is non-judgmental and non-discriminatory. .Consider ... frames on a specific group of patients.The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan … more