- Molina Healthcare (Salt Lake City, UT)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- International Medical Group (Indianapolis, IN)
- …members to utilize alternative care settings when appropriate. + Identify potential large case management cases by diagnosis, dollar amount and/or high ... of medical services and refer those identified for large case management . + Document information and status...assigned. QUALIFICATIONS + Current and active Nursing license - Registered Nurse + Minimum two years acute… more
- Children's Home Healthcare (Albuquerque, NM)
- …an RN , BSN preferred + Current CPR + At least 2 years experience as a Registered Nurse + At least 1 year experience as a Clinical Supervisor in Home Health ... LICENSE* Children's Home Healthcare is now hiring for a RN Clinical Supervisor/ Case Manager! Children's HH is...skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for… more
- UNC Health Care (Lenoir, NC)
- …7. Payer Communication: a. Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely ... major in nursing within 7 years of employment date. **Licensure/Certification Requirements:** * Registered Nurse with a valid license to practice in North… more
- Bozeman Health (Bozeman, MT)
- …by regulatory agencies, DNV and the hospital administrative team. Provides oversight of case management , discharge planning and utilization review. Provides ... Position Summary: The System Manager of Case Management is responsible for assisting...Bachelor of Science in Nursing + Current Montana Licensure ( Registered Nurse ) + Three (3) years leadership… more
- Providence (Burbank, CA)
- …in Healthcare related field (Acute, Ambulatory, Post-Acute, etc.). + 2 years experience in Case Management (Care Coordination or Utilization Management ) ... types of care by US News & World Report. Case Management is a collaborative practice including...Qualifications:** + Bachelor's Degree, or equivalent education/experience. + California Registered Nurse License upon hire. + 2… more
- Texas Health Resources (Dallas, TX)
- …required. * One year of hospital case management experience is preferred. * RN - Registered Nurse Upon Hire Req or LMSW - Licensed Master Social ... Hire Req And * BCCMN - Board Certified Nursing Case Management 12 Months Req or ACM...resources. Assesses patient information utilizing psychological and medical knowledge. Utilization Review and Management * Performs effective… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …this position\. + This job requires digital literacy assessment\. **Job Qualifications** _License_ + Registered Nurse \( RN \) with active license in the state ... BlueCross BlueShield of Tennessee \(BCBST\) is seeking a skilled and compassionate Registered Nurse to join our fast\-paced, high\-performing team\. In this… more
- Dignity Health (Rancho Cordova, CA)
- …of Nursing degree. - Clear and current CA Registered Nurse ( RN ) license. - Comprehensive knowledge of care management and discharge planning, Medicare ... and Joint Commission standards. **Preferred Qualifications:** - Accredited Case Manager, Case Management Nurse , and/or Certified Case Manager… more
- ChenMed (Newport News, VA)
- …providers. We're rapidly expanding and we need great people to join our team. The Nurse Case Manager 1 ( RN ) is responsible for achieving positive patient ... post-acute facilities, as well as, their home environments. The Nurse Case Manager 1 ( RN )...to preferred providers. + Coordinates the integration of social services/ case management functions in the pre-acute, ER,… more