- Carle Health (Champaign, IL)
- …for improving patient care outcomes. The incumbent will have a deep understanding of utilization review and case management principles, case management ... experience - External Applicants Only** Hybrid Option The Registered Nurse (RN) who serves in the role of System...experience 2+ years Responsibilities Maintain current knowledge of case management and utilization review trends… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …looking to add a **Supervisor of Clinical Management ** to the BlueCare Utilization Management team\. In this leadership role, you'll oversee a dedicated ... group of nurses who conduct utilization management reviews to assess medical necessity\....responsibilities include:** + Supervising daily operations of the clinical review team + Ensuring compliance with CMS and URAC… more
- Mount Sinai Health System (New York, NY)
- …the Daily Management Board process/practice improvement activities to facilitate the utilization of evidence and data related to Nurse Sensitive Indicators ... **Job Description** The Director of Nursing Professional Practice is a professional nurse with broad knowledge and skill in the professional practice standards, NYS… more
- The County of Los Angeles (Los Angeles, CA)
- …the following: + Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL REQUIREMENT ... the work of staff, and evaluating employee performance. For this examination, Utilization Review is defined as provides technical and administrative direction… 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...review duties, seeking guidance from the product line nurse (s), and other members of the healthcare team and… more
- ChenMed (Portsmouth, VA)
- …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... we need great people to join our team. The Nurse Case Manager 1 (RN) is responsible for achieving...achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from… more
- Select Medical (Lake Worth, FL)
- …functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge planning, ... focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with… more
- Molina Healthcare (Las Vegas, NV)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… more
- Pacific Medical Centers (Renton, WA)
- …The Supervisor Care Management RN is responsible for the supervision of case management (CM) and utilization management (UM) functions of US Family ... and processed in a timely manner. It includes timely review of medical necessity and authorization for all admitted...USFHP Medical Director(s) to develop and implement strategic case management and utilization management yearly… more
- Community Health Systems (Bentonville, AR)
- …**Qualifications** + 2-4 years of clinical nursing experience required + Experience in utilization review , case management , or discharge planning preferred ... **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities under the… more