- Alameda Health System (Oakland, CA)
- …off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational ... Director , Utilization Management + Oakland, CA...background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …groups and clinical committees. Essential Qualifications + Active and unrestricted license as a Registered Nurse ( RN ). + Bachelor's degree in nursing, (or ... About The Role The Director , Utilization Management (UM) will manage...Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems , providers as well as other TPAs, and enables… more
- Tufts Medicine (Burlington, MA)
- …**Minimum Qualifications:** 1. Bachelor of Science in Nursing (BSN). 2.Massachusetts RN Licensure. 3. Current certification in case/ utilization management (ACM, ... MA. **About Tufts Medicine:** Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver… more
- Commonwealth Care Alliance (Boston, MA)
- 023520 Clin Alli-Physicians Group **Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review, the Utilization ... will be responsible for providing leadership and subject matter expertise to our utilization management (UM) group. This role is a key role in helping our… more
- Humana (Lansing, MI)
- …care management. + Collaborate with the Chief Medical Officer, Quality Improvement Director , Utilization Director , Population Health Management Director ... Director to oversee the processing of LTSS utilization management requests. + Oversee the partnership with AAAs...other Humana leadership to identify the clinical tools and systems to support LTSS care management activities. + Participates… more
- Prime Healthcare (Inglewood, CA)
- …outcomes and reducing readmissions. #LI-CC2 Qualifications Required qualifications: 1. CA Registered Nurse 2. Bachelor's of Science in Nursing3. Grandfathered ... As a member of Prime Healthcare, a Top-15 hospital system in the United States, Centinela Hospital Medical Center...part-time. Responsibilities We are seeking a strategic and compassionate Director of Case Management to lead our dynamic Case… more
- Commonwealth Care Alliance (Boston, MA)
- 011200 CCA-Central Clin Ops Leadership **Position Summary:** Reporting to the Sr. Medical Director of Utilization Management (UM) and Policy, the Medical Policy ... to the population serviced by CCA. The Medical Policy Director is an independent contributor who works in partnership...workflows are streamlined and maintained + Develop and maintain systems for tracking medical policy reviews and revisions. +… more
- BrightSpring Health Services (Sacramento, CA)
- …Education: Degree from an accredited school of nursing Qualifications:* Must be a Licensed Registered Nurse ( RN ) in good standing and currently licensed by ... performance reviews* Responsible to ensure that there is a nurse on call after hours for all homes (and...to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at… more
- RWJBarnabas Health (Newark, NJ)
- Asst Director Patient Care Registered Nurse ( RN ) Full Time Days CTICUReq #:0000204650 Category:Leadership Status:Full-Time Shift:Day Facility:Newark Beth ... Location: 201 LYONS AVENUE, NEWARK, NJ 07112-2027 Job Title:Asst Director Patient Care Location:Newark Beth Israel Medical Ctr Department...you need. Required Certifications and Licenses: + Active NJ RN License or Multistate RN License with… more
- UTMB Health (Friendswood, TX)
- …from an accredited school of Professional Nursing + Current Texas Nursing Licensure as a Registered Nurse ( RN ). + Minimum of five (5) years full-time wage ... Director and/or Assistant Director of Utilization Review/Case Management. + Maintains a documentation system...earning experience as a professional nurse in a healthcare setting with at least two… more