- Alameda Health System (Oakland, CA)
- …plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic ... hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care....Required Licenses/Certifications : Valid license to practice as a Registered Nurse in the State of California.… more
- University Health (San Antonio, TX)
- …of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager ... years recent, full time hospital experience preferred. Work experience in case management , utilization review, or hospital quality assurance experience is… more
- AnMed Health (Anderson, SC)
- …continued stay/concurrent review, retrospective review, bed status management , resource utilization management , regulatory compliance , and related denial ... is responsible for performing the daily operations of the Utilization Management program at AnMed within the...of severity of illness and intensity of services, regulatory compliance with documentation and physician orders. + Reviews all… more
- UNC Health Care (Kinston, NC)
- …clinical experience as a Registered Nurse required. + 2 years utilization review, care management , or compliance experience preferred. + Minimum 1 ... management preferred. + **LICENSURE/REGISTRATION/CERTIFICATION** + Licensed to practice as a Registered Nurse in the state of North Carolina. **Job Details**… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …colors to blue. The Role:The Compliance Program Consultant will focus on utilization management compliance and audit readiness activities such as ... Management 's (HMM) and delegate's compliance with the applicable NCQA utilization management standards and state and federal regulations. The Team: This… more
- Community Health Systems (Franklin, TN)
- …evaluating the necessity, appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts ... extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key...regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse -… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day ... service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has...has a key role in ensuring CCA meets CMS compliance standards in the area of service decisions and… more
- Katmai (Fort Carson, CO)
- …Red Cross. + Three (3) years within the last four (4) years as a registered nurse in utilization management . + One (1) year of experience in UR/UM and ... Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE...full, active, and unrestricted license to practice as a registered nurse . + Must be a graduate… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse ( RN ) -...Management and Compliance policies, InterQual, Transition Management , Utilization Management , and other ... dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the...for case management scope of services including: Utilization Management supporting medical necessity and denial… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse ( RN ) - Nursing Admin - 2506002696 Description : DMC Detroit Receiving Hospital , Michigan's first Level I Trauma Center, helped pioneer the ... DMC Rosa Parks Geriatric Center of Excellence. SUMMARY The Registered Nurse ( RN ) is a...prepares patient for discharge, utilizing established clinical pathways. The RN reports directly to senior unit management ,… more
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