- Commonwealth Care Alliance (Boston, MA)
- …Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key...Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy +… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, ... medical directors/physician reviewers, network physicians, and network facilities to...most appropriate course of action + Provides education to nurse and therapist reviewers regarding appeal updates and process… more
- ERP International (Hurlburt Field, FL)
- **Overview** ERP International is seeking a full time ** Registered Nurse ( RN ) Case Manager** in support of the 1st Special Operations Medical Group at ... Management Specialist (CDMS) Association of Rehabilitation Nurses: Certified Rehabilitation Registered Nurse (CRRN) American Board for Occupational Health… more
- ERP International (Twentynine Palms, CA)
- **Overview** ERP International is seeking ** Registered Nurse ( RN ) Case Managers** for full-time positions in support of the **Naval Hospital Twentynine ... Management Specialist (CDMS) o Association of Rehabilitation Nurses: Certified Rehabilitation Registered Nurse (CRRN) o American Board for Occupational Health… more
- ERP International (Tinker AFB, OK)
- **Overview** ERP International, LLC is seeking a ** Registered Nurse - Case Manager** for a full-time position supporting **SHG Clinic** in support of **Tinker ... no limitations, stipulations or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction. Security** : Must possess… more
- Stony Brook University (Stony Brook, NY)
- …communication skills while adhering to our high standard of excellence. **Duties of a RN Case Manager in the Care Management Department may include the following ... assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Commonwealth Care Alliance (Boston, MA)
- …staff selection, training, and performance monitoring and - Leads the Utilization Management team in managing and continuously improving UM program design, ... or Health related field preferred Required Licensing: - active RN license required Required Experience: - 7-10 years -...minimum five (5) years of leadership experience in Utilization Management ( UM ) or nursing leadership to include… more
- Molina Healthcare (Syracuse, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... and cost-effective member care. The candidate must have a RN licensure and experience with medical surgical,...intensive care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work… more
- UPMC (Pittsburgh, PA)
- UPMC Home Health is Hiring a Full-Time Registered Nurse ( RN ) for the Uniontown and Surrounding Areas Are you a nurse looking for a rewarding career where ... patients' plans of care in collaboration with physicians, patients, and utilization management ( UM ) professionals to meet physicians' orders and patients' needs.… more
- 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...required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and member/provider… more
