- CareFirst (Baltimore, MD)
- …& Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of health ... work experience. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure. **Experience:** 3 years… more
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist/Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital ... Utilization Review Program and makes appropriate referrals to designated...Education: Holds a current Texas license as a Registered Nurse OR a current Texas Licensed Vocational Nurse… more
- Centene Corporation (Austin, TX)
- …and criteria + Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers as appropriate to discuss ... to members and their families regrading ABA and BH utilization process + Provides feedback to leadership on opportunities...Certified Behavior Analyst (BCBA) required + RN - Registered Nurse - State Licensure and/or Compact State Licensure RN… more
- Centene Corporation (Salem, OR)
- …discharge planning + Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members and their families ... regrading BH utilization process + Interacts with BH healthcare providers as...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Penn Medicine (Lancaster, PA)
- …Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for patients by ... thrive under pressure, we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible for evaluating medical records to… more
- Prime Healthcare (Inglewood, CA)
- …and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patients receive ... case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Additionally,… more
- Baystate Health (Springfield, MA)
- …- Maximum $46.22 - $53.13 - $62.85 **Per Diem Hospital Case Manager / Utilization Management** The **RN Hospital Case Manager** is a registered nurse responsible ... MD's about safe plan for transitions + Leads the team to ensure appropriate utilization of patient resources and directs care to other settings when appropriate +… more
- TEKsystems (Canoga Park, CA)
- …This role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong ... + Active LVN or RN license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with HMO/Medicare claims, audits, and denials +… more
- Sharp HealthCare (San Diego, CA)
- …Degree in Nursing; Bachelor's Degree in Nursing; Master's Degree; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Case Manager (CCM) ... acute care or clinical experience in area of specialty. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred Qualifications** + Master's… more
- CVS Health (Baton Rouge, LA)
- …it all with heart, each and every day. **Position Summary** The Utilization Management Coordinator/UMNC assists in ensuring that authorization request decisions are ... ie generators, housing, rentals) * Collaborate with care management and utilization management teams in monitoring behavioral health services, assure assessments for… more