- Aequor (New York, NY)
- …nursing professional Minimum experience of 1-3 years in case management, utilization review and/or quality assurance Experience in episodic care, wellness care ... and counseling of adults Proficiency in use of electronic medical record keeping systems desirable BLS certification required Optional: Case Management and COHN-S certifications Major Responsibilities: Assist in coordination of clinical operations, including… more
- CHRISTUS Health (San Antonio, TX)
- …and operations for assigned areas; at CHRISTUS St. Patrick Hospital. The nurse manager affects departmental outcomes through interpretation, implementation, and ... excellence in patient care, patient experience and patient outcomes. Effectively manages utilization of staff and material resources so that the most therapeutically… more
- CHRISTUS Health (San Antonio, TX)
- …nursing practice and operations for assigned areas; Patrick Hospital. The nurse manager affects departmental outcomes through interpretation, implementation, and ... excellence in patient care, patient experience and patient outcomes. Effectively manages utilization of staff and material resources so that the most therapeutically… more
- CHRISTUS Health (San Antonio, TX)
- …nursing and business operations for CSR Emergency Room (Bitters/Banders). The nurse manager affects departmental outcomes through interpretation, implementation, ... promote excellence in patient care and enhance patient outcomes. Effectively manages utilization of staff and material resources so that the most therapeutically… more
- CHRISTUS Health (Alamogordo, NM)
- …monitoring, and reporting individual cases and/or trends to the infection control nurse . Performs utilization management functions as required by payer source. ... Director when there are actual or potential sources of under- or over- utilization . Collaborates with providers, nurses, patients, families, and other care providers… more
- UT Health Tyler (Tyler, TX)
- Overview Join our team as a full-time Manager of Case Management in Tyler, TX. Fulfilling your purpose begins here: People First, Always. Here's how we take care of ... celebrate differences and treat one another with respect. Responsibilities The Manager of Case Management has overall responsibility for hospital utilization… more
- Trinity Health (Fresno, CA)
- **Employment Type:** Full time **Shift:** **Description:** **Are you an experience RN Manager , Utilization Review of Acute Care seeking your next adventure?** ... **Duration:** 13-week Assignment The Interim Utilization Management , RN Manager is responsible...and hospital staff **Requirements** + State of California Registered Nurse (RN) License. + Current American Heart Association (AHA)… more
- University Medicine (East Providence, RI)
- …home members to assist the patient to the right level of care and decrease unnecessary utilization . The nurse case manager is an active participant in the ... SUMMARY: Reporting to the Manager of Case Management, the nurse ...high risk case management (eg rising risk, frequent ED utilization ). The NCM helps Brown Medicine achieve the triple… more
- UNC Health Care (Chapel Hill, NC)
- …communities we serve. RN Utilization Manager position specifically for a Utilization Manager /Clinical Appeals Nurse . This person is based at the ... care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… more
- Arnot Health (Elmira, NY)
- …areas suitable for nursing research. + Promotes research-based practice. Standard VIII. Resource Utilization The Nurse Manager evaluates and administers the ... DUTIES AND RESPONSIBILITIES: Standards of Care Standard I. Assessment The Nurse Manager develops, maintains, and evaluates patient/client and staff… more
- Beth Israel Lahey Health (Burlington, MA)
- …**Scheduled Hours:** 40 **Work Shift:** Day (United States of America) Joint role of Case Manager and Utilization Review Nurse Hospital at Home Full Time ... 8:00am-4:30pm weekend and holiday rotations required **Job Description:** The Inpatient Registered Nurse (RN) Case Manager for Hospital at Home Care Transitions… more
- Providence (Medford, OR)
- …and geriatric, based on population focus. Duties also include complex discharge planning and utilization review. The Nurse Case Manager must be competent to ... **Description** The RN Case Manager is an expert professional registered nurse...year home health, mental health, substance use, hospice, and/or utilization review. + Progressive nursing leadership experience, including charge… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- University of Utah Health (Salt Lake City, UT)
- …advancement, and overall patient outcomes. **Responsibilities** + Applies approved utilization criteria to monitor appropriateness of admissions with associated ... or third-party payer. + Alerts and discusses with physician/provider and case manager /discharge planner when patient no longer meets medical necessity criteria for… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Milford Regional Medical Center (Milford, MA)
- …to our community with dignity, compassion, and respect. Statement of Purpose: The Utilization Review Nurse is responsible for utilization management at ... Nursing required Masters in Healthcare preferred Certification/License: Massachusetts Registered Nurse licensure required Certified Case Manager , preferred… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Role BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality ... oversite. This position reports to the Clinical Program Manager . This job description is not designed to cover...Complex Care Needs. Essential Qualifications + Current licensed Registered Nurse (RN) with state licensure. Must retain active and… more
- Glens Falls Hospital (Glens Falls, NY)
- …hours per week, can be foundhere. **Job:** **Nursing - Case Management* **Title:** *Registered Nurse - Utilization Review Nurse - Care Management (Sign-On ... timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing… more
- Travelers Insurance Company (Buffalo, NY)
- …Imagine loving what you do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual base salary range ... Is the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective,… more
- Sharp HealthCare (San Diego, CA)
- …Will Do** As a member of the System Integrated Care Management (ICM) team the Utilization Manager (UM) II position supports utilization review functions to ... Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American Case… more
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