- General Dynamics Information Technology (Hurlburt Field, FL)
- …proof of all training/certs/documentation. + Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential ... a case manager by a recognized certifying organization, ie Commission for Case Management Certification or American Nurse Credentialing Center. + Current RN… more
- Baystate Health (Springfield, MA)
- …Health Center** The **ACO Nurse Care Manager i** s responsible for the management of care for a defined group of patients including complex care management , ... room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that...management application is required and is vital. Care management program metrics including, emergency room utilization ,… more
- HCA Healthcare (Mcallen, TX)
- …national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + Transition ... patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and...growth, we encourage you to apply for our Registered Nurse Case Manager PRN opening. We review … more
- HCA Healthcare (Houston, TX)
- …national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + Transition ... patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and...growth, we encourage you to apply for our Registered Nurse Case Manager opening. We promptly review … more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Management (UM) services to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal ... accurate decisions + Ensure strict adherence to Appeals and Utilization Management (UM) processes and regulatory and...URAC, NCQA, and ERISA + Proficiency in Clinical Appeals, Utilization Review , and Grievance processes including benefit… more
- Texas Health Resources (Dallas, TX)
- Nurse Manager II - Emergency Department _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for qualified ... unit, chest pain dedicated suites and a Sexual Assault Nurse Examiner (SANE) unit. We average about 200 patients...Center of Excellence in Robotic Surgery by the Surgical Review Corporation (SRC), a leading organization dedicated to advancing… more
- Lawrence General Hospital (Lawrence, MA)
- …appropriate referrals and facilitates appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care ... experience in an acute care setting with discharge planning, continuing care, care management , and utilization review . + Five years clinical nursing… more
- Sutter Health (Burlingame, CA)
- …case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of ... management , quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers… more
- AdventHealth (Winter Park, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...+ Health-related masters degree or MSN + Prior Care Management / Utilization Management experience +… more
- HCA Healthcare (Corpus Christi, TX)
- …Do you want to join an organization that invests in you as a(an) Registered Nurse Case Manager PRN? At Corpus Christi Medical Center, you come first. HCA Healthcare ... a difference. We are looking for a dedicated Registered Nurse Case Manager PRN like you to be a...patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and… more