• Utilization Review RN Case

    Penn Medicine (Philadelphia, PA)
    …or Equivalent Experience: + Bachelor of Arts or Science (Required) + Utilization Review experience (Required) + Bachelor's Degree in Nursing required.2+ ... activity in Canopy concurrentlyAccounts for all patient days accurately in CanopyEnters review indicating "pending" status of case if outcome not determined and… more
    Penn Medicine (08/19/25)
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  • Oncology Prior Authorization Case

    University of Miami (Miami, FL)
    …System Department of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. ... and retrospective chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare team… more
    University of Miami (08/21/25)
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  • Oncology Prior Authorization Case

    University of Miami (Miami, FL)
    …please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Utilization Review Case Manager ... of Miami is currently seeking a Prior Authorization Nurse Case Manager . The incumbent purose is to...forth by the payer or clinical guidelines + Accurate review of coverage benefits and payer policy limitations to… more
    University of Miami (08/23/25)
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  • RN Case Manager - Travel $3042/Wk

    Amergis (French Camp, CA)
    …hours per week RNs will be doing denials, discharge planning, and utilization review **Needs Case Manager Experience in ACUTE setting** Current Discharge ... Planning experience Denials experience Utilization review experience InterQual experience Working with...experience with PERFORMANT or CDCR denials DESIRED The RN Case Manager is responsible for coordinatingcontinuum of… more
    Amergis (08/30/25)
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  • Case Manager Registered Nurse- Field…

    CVS Health (Charleston, WV)
    …* Foster care experience * Crisis intervention skills * Managed care/ utilization review experience * Certified Case Manager (CCM) certification * ... Mercer, Summers, Monroe, Greenbrier, Pocahontas, Kanawha, and Fayette.** The Case Manager RN (CM RN) is responsible...face member visits * Using clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more
    CVS Health (08/01/25)
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  • RN/ Case Manager -MSH- Case

    Mount Sinai Health System (New York, NY)
    …homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager or a minimum of 3-5 years experience ... **Job Description** **RN/ Case Manager MSH Case ...a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case more
    Mount Sinai Health System (08/28/25)
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  • RN/ Case Manager -Inpatient-Mount…

    Mount Sinai Health System (New York, NY)
    …preferred. + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + ... **Job Description** RN/ Case Manager Mount Sinai West FT...1. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case more
    Mount Sinai Health System (08/16/25)
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  • Per Diem RN Case Manager

    Children's Hospital Boston (Boston, MA)
    80451BRJob Posting Title:Per Diem RN Case Manager , Utilization Management/ReviewDepartment:Patient Services-Patient Care ... required, pediatric experience preferred. + Experience as a Case Manager (Discharge Planning and or Utilization Management) preferred. Licensure/… more
    Children's Hospital Boston (06/16/25)
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  • Enhanced Care Management Clinical Specialist II

    LA Care Health Plan (Los Angeles, CA)
    …California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or… more
    LA Care Health Plan (07/16/25)
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  • Registered Nurse - Case Manager

    Mayo Clinic (Rochester, MN)
    …physicians and multi-disciplinary teams. Major Functions of the RN Case Manager include: Utilization Review , including concurrent admission status and ... resource utilization , and clinical documentation. The RN Case Manager will function within the Mayo...within a creative and challenging work environment. Experience in utilization review , ability to navigate medical records,… more
    Mayo Clinic (06/14/25)
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