- Humana (Lincoln, NE)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Actalent (Atlanta, GA)
- Utilization Review - Registered Nurse Job...- Appeals, and Risk Management . Essential Skills + Registered Nurse ( RN ) with a valid ... license in GA or Compact. + 1+ years of experience in Utilization Management (UM). + 1+ years of experience in managed care. Additional Skills & Qualifications +… more
- HCA Healthcare (Houston, TX)
- …service organizations, agencies and healthcare facilities. **What qualifications you will need:** + ( RN ) Registered Nurse + Associate Degree, or Bachelors ... from any other healthcare provider. We are seeking a(an) Registered Nurse Case Manager to join our...and overall evaluation of individual patient needs. Care coordination, utilization review and management , as well as… more
- Dignity Health (Santa Maria, CA)
- …+ Implements care as assigned by Registered Nurse or Licensed Vocational Nurse . + Notifies appropriate RN or LVN of changes in orders. + Accurately ... unit phone communication. Under the direct supervision of a registered nurse or licensed vocational nurse...Copies charts for transfers/discharges + Posts lab/radiology results and utilization review summary sheets + Thins ECU and sub-acute… more
- Beth Israel Lahey Health (Exeter, NH)
- Registered Nurse Case Manager + Full Time + Exeter, NH 03833 ... the patient's health care needs following the current phase of illness. **Requirements** + Registered Nurse - NH State or Compact State + BSN Preferred +… more
- CVS Health (Oklahoma City, OK)
- …and timely discharge, appropriate follow-up care, and next steps. + Coordinate with the Utilization Management team to review medical and payer records to ensure ... teams across various sites of care (eg ED, hospital, SNF , primary care clinics). This role prioritizes the relationship...stay and identify any barriers to discharge. + Assist Utilization Management team with access to external… more
- AmeriHealth Caritas (Lafayette, LA)
- …in a fast-paced, high-volume utilization review environment. **Licensure:** + An active Registered Nurse ( RN ) license in Louisiana or multi state license ... **Role Overview:** Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services,… more
- Sharp HealthCare (La Mesa, CA)
- …3 Years Recent acute care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA Board of Registered Nursing ... Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA...and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- CenterWell (Little Rock, AR)
- … RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
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