- ERP International (Yuma, AZ)
- **Overview** ERP International, LLC is seeking a ** Registered Nurse - Case Manager** for a full-time position at the Camp Pendleton **Branch Health Clinic** in ... office, and the Managed Care Support Contractor. + Maintain adherence to JCAHO, URAC, CMSA and other regulatory...Licensure:** Current, full, active and unrestricted license as a Registered Nurse Security** : Must possess ability… more
- ERP International (Cherry Point, NC)
- **Overview** ERP International is seeking full-time ** Registered Nurse ( RN ) Case Manager** in support of theNaval Health Clinic Cherry Point, NC. Apply ... Management Specialist (CDMS) o Association of Rehabilitation Nurses: Certified Rehabilitation Registered Nurse (CRRN) o American Board for Occupational Health… more
- Highmark Health (Helena, MT)
- …+ Experience in UM /CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN license ... discipline. + Function in accordance with applicable state, federal laws and regulatory compliance. + Function in accordance with applicable state, federal laws and… more
- Sharp HealthCare (San Diego, CA)
- …**Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... medical management activities to include tracking, trending and analyzing UM data. Works in collaboration with regional medical directors,...experience, preferably in a managed care setting + California Registered Nurse ( RN ) - CA… more
- Highmark Health (Baton Rouge, LA)
- … UM /CM/QA/Managed Care **LICENSES AND CERTIFICATIONS** **Required** + Current RN state licensure required. Additional specific state licensure(s) may be required ... discipline. + Function in accordance with applicable state, federal laws and regulatory compliance. + Implement all care management reviews according to accepted and… more
- Beth Israel Lahey Health (Burlington, MA)
- …Degree, Master's Degree preferred **Licensure, Certification, Registration:** Current license as a Registered Nurse **Skills, Knowledge & Abilities** : + Current ... making a difference in people's lives.** Manages the Utilization Management ( UM ) team, maintaining effective and efficient processes for determining appropriate… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... resources and support. * *Utilization Review Committee:*Establish committee to ensure CMS and regulatory compliance.* *Develop and maintain a UM plan to guide… more
- 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 ... to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements + Provides decision-making guidance… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …improvements. Key Responsibilities: + Implement strategic and operational goals for the CM/ UM group; implement and monitor supporting plans + Oversee the CM/ UM ... and demographically diverse population + Serve as a mentor and advisor to CM and UM 's as they work through complex or particularly unique cases + Become an expert of… more
- San Antonio Behavioral Health (San Antonio, TX)
- …May consult with staff as needed. Essential Duties: + Collaborate and set standards with registered nurse ( RN ) case managers (CMs) and outcome managers to ... treatment plans and status of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and… more