• Utilization Management Nurse (RN)…

    WellSpan Health (York, PA)
    Utilization Management Nurse (RN) - Case Management - Day (Temporar Location: WellSpan Health, York, PA Schedule: Full Time Schedule Temporary Role ... WellSpan's geographic footprint. General Summary Performs a variety of reviews and applies utilization and case management techniques to determine the most… more
    WellSpan Health (05/02/25)
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  • Manager, Utilization Management

    CoreCivic (Brentwood, TN)
    …will pay $82,000 - $97,400 with a 10% bonus eligible._ **SUMMARY:** The Manager, Utilization Management / Case Management provides Utilization Review ... the organization under the direction of the Senior Director, Case Management and within the established policies...government laws and regulations. + Manages a team of utilization management nurses.Provides direction and supports staff… more
    CoreCivic (04/29/25)
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  • Case Manager (RN) - PRN Utilization

    Houston Methodist (The Woodlands, TX)
    …for state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement ... PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient population on a designated unit(s). This… more
    Houston Methodist (02/08/25)
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  • Utilization Management Reviewer…

    Excellus BlueCross BlueShield (Utica, NY)
    …cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as ... depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of… more
    Excellus BlueCross BlueShield (05/02/25)
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  • Integrated Care Management Assistant…

    McLaren Health Care (Detroit, MI)
    …degree in coding/medical records/billing or healthcare related field + Two years of case management or utilization review, billing, or coding experience ... observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more
    McLaren Health Care (04/10/25)
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  • Utilization Management Manager,…

    UCLA Health (Los Angeles, CA)
    …can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team of UM ... (BSN) degree required + Five or more years of utilization management required + Four or more...complex federal and private insurance regulations + Ability to travel /attend off-site meetings and conferences + ACM - Accredited… more
    UCLA Health (03/04/25)
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  • Registered Nurse Care Manager Utilization

    Catholic Health (Buffalo, NY)
    …hospital and community or obtained within 6 months + National Certification in Case Management preferred EXPERIENCE + Two (2) years medical surgical nursing ... Review, as an active member of the Care Management and interdisciplinary care team, provides comprehensive Utilization...utilization review experience in the role of a Case Manager or Disease Manager, Population Health, Discharge Planning… more
    Catholic Health (05/01/25)
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  • Program Mgr UR/ Case Management

    UTMB Health (Friendswood, TX)
    …ensure optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review/ Case Management program by utilizing clinical ... + Supervises the operational management of the Utilization Review/ Case Management program to...Standard office equipment. **_WORK ENVIRONMENT_** **:** + May involve travel . + May involve occasional shift work and weekends… more
    UTMB Health (04/04/25)
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  • Manager - Case Management and Social…

    Houston Methodist (Houston, TX)
    …(MSW) + Master's in nursing preferred **WORK EXPERIENCE** + Five years experience in inpatient case management , social work or utilization management or ... to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and… more
    Houston Methodist (04/29/25)
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  • Director - Case Management & Social…

    Houston Methodist (Houston, TX)
    …Mgmt Social Svcs position is responsible for strategy, function and operations of the Case Management & Social Work department. This position is an integrated, ... entity committees as a voice for the department. + Sets direction for Case Management /Social Services which supports strategic and operational plans, and overall… more
    Houston Methodist (05/02/25)
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