- Excellus BlueCross BlueShield (Rochester, NY)
- …cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as ... depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of… more
- Centene Corporation (New York, NY)
- …in Nursing preferred. 3+ years of combined nursing and appeal and grievance, or utilization management or case management experience. Previous ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- UNC Health Care (Smithfield, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... medical discharge planning issues, continuing care needs by initiating appropriate case management referrals. Initiates appropriate social work referrals. 3.… more
- St. Bernard's Medical Center (Jonesboro, AR)
- …REQUIREMENTS + Education + Current Arkansas State RN license. + Experience + RN with previous case management experience preferred, but not necessary. ... continuity of care and cost effectiveness through the integration and functions of case management and utilization review. The person in this position is… more
- Vanderbilt University Medical Center (Nashville, TN)
- …through preeminent programs in patient care, education, and research. **Organization:** Utilization Management **Job Summary:** Coordinate, monitor, and evaluate ... the operation of Utilization Management Section of the Utilization Management Department of the Medical Center. . KEY RESPONSIBILITIES + Develop work… more
- Providence (Mission Hills, CA)
- … Utilization Management , medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a ... **Description** ** RN Utilization Review at Providence Holy...**Required Qualifications:** + Associate's Degree - Nursing. + California Registered Nurse License upon hire. + 2… more
- Providence (Mission Hills, CA)
- … Utilization Management , medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a ... **Description** ** RN Utilization Review at Providence Holy...Qualifications:** + Associate's Degree Nursing. + Upon hire: California Registered Nurse License. + 2 years Experience… more
- HonorHealth (AZ)
- …acute care setting. Required1 year experience in UR/UM or Case Management RequiredLicenses and CertificationsRegistered Nurse ( RN ) State And/Or Compact ... here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of… more
- Corewell Health (Grand Rapids, MI)
- …nursing and or case management /managed care or related field Preferred + Registered Nurse ( RN ) - State of Michigan Upon Hire required + Basic ... within 7 years for those who start in this RN role on or after January 1, 2017 (Spectrum...2 years of relevant experience clinical nursing and or case management /managed care or related field Required… 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 ... CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board...appropriateness of the level of care. For this examination, Case Management is a collaborative process that… more