- Commonwealth Care Alliance (Boston, MA)
- …services, procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and ... managing the daily operation of the Utilization Management Review Nurse and...decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time **Shift:** ... : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management , you...resource for navigating post-acute care services. **Minimum Qualifications:** + RN licensed by the State of Maryland or Compact… more
- Children's Hospital Boston (Boston, MA)
- 80451BRJob Posting Title:Per Diem RN Case Manager , Utilization Management /ReviewDepartment:Patient Services-Patient Care ... a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: + Current...preferred. Licensure/ Certifications: + Current Massachusetts license as a Registered Nurse ( RN ) + A… more
- Tufts Medicine (Burlington, MA)
- …with the coordination of the Utilization Management Committee. The Utilization Management Operations Manager follows the system's Utilization ... to Utilization Review departments and UM vendor management . The UM Operations Manager is responsible...and ensuring optimum outcomes. **Job Description** **Minimum Qualifications:** 1. Registered Nurse (BSN or higher) or other… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... **Join Our Team of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... compliance reviews as needed. + Continuously monitors regulatory requirements for Utilization Management . + Attends Mandatory Education programs required by… more
- Prime Healthcare (Weslaco, TX)
- …Status Full Time Shift Days Connect With Us! (https://careers-primehealthcare.icims.com/jobs/210205/ registered - nurse -case- manager utilization - ... Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to the… more
- Healthfirst (IA)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- Prime Healthcare (Montclair, CA)
- …Shift Days Connect With Us! (https://careers-primehealthcare.icims.com/jobs/208989/case- manager -%28rn%29 utilization - management ... an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April...Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute… more
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