- The University of Vermont Health Network (Plattsburgh, NY)
- Unit Description: The Utilization Review Team monitors, collects and analyzes data and evaluates variances of resource utilization , complications and overall ... and promotes the efficient and effective use of patient services. The Utilization Review Team's role in data collection, analysis and summarization supports the… more
- UNC Health (Chapel Hill, NC)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The Care Manager must be ... UNC Health is seeking a Registered Nurse (RN) Care Manager for a nursing job...Refer administrative tasks (eg, faxing, form processing) to Care Management Assistant. Consult Social Worker and/or Utilization … more
- Dana-Farber Cancer Institute (Boston, MA)
- …the highest quality patient experience while maximizing provider time and space utilization . The Nurse Director uses extensive theoretical, evidence-based, and ... one of which must be in Nursing.Licensed as a Registered Nurse in the Commonwealth of Massachusetts.Hematology-Oncology experience required. Management experience… more
- Dana-Farber Cancer Institute (South Boston, MA)
- …the highest quality patient experience while maximizing provider time and space utilization . The Nurse Director uses extensive theoretical, evidence-based, and ... for the planning, implementation and evaluation of clinical operations and personnel management of the assigned patient care unit. He/she acts as a liaison… more
- Wilson Medical Center (Wilson, NC)
- …external delivery of healthcare services. The Case Manager integrates the roles of Utilization Management , Case Management , and Discharge Planning. The Case ... 7. The Case Manager independently performs clinical reviews based on the Utilization Review Plan with follow-up actions identified for medical necessity and level… more
- UT Health Tyler (Tyler, TX)
- …The Manager of Case Management has overall responsibility for hospital utilization management , transition management and operational management ... of the Case Management Department to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe… more
- Advocate Aurora Health (Adell, WI)
- …with status report on a regular basis.Communicates problems to physicians and management and clearly states plans, actions and goals so changes are reflected ... caseload for optimal functional and financial outcomes; reviews caseload for Low Utilization Payment Adjustments (LUPA), optimal number of visits based on progress,… more
- WellSpan Health (York, PA)
- Utilization Management Nurse (RN) - Case Management - Day (Temporary) Location: WellSpan Health, York, PA Schedule: Full Time Sign-On Bonus Eligible ... effective and quality health care. Provides leadership in the integration of utilization management principles throughout the System. Responsible for screening… more
- CVS Health (Raleigh, NC)
- …is part of the dedicated team supporting the membership of plan sponsor. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and employee… more
- CVS Health (Raleigh, NC)
- …live in any state. There is no travel expected with this position. As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... solutions to make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and employee… 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 ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve… more
- Humana (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Montgomery, AL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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 ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and approve… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity ... any time with or without notice. Primary Responsibilities * Perform prospective utilization reviews and first level determinations for members using evidenced based… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. This ... any time with or without notice. Primary Responsibilities + Performs concurrent utilization reviews (Acute, SNF, LTACH, ARF) and first level determination approvals… more
- CVS Health (Austin, TX)
- …make health care more personal, convenient and affordable. Position Summary Precertification: Utilization Management Nurse Consultant + Utilizes clinical ... Qualifications + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...(twice per month) Preferred Qualifications + Prior Authorization or Utilization Management experience + Managed care experience… more
- Insight Global (Philadelphia, PA)
- …A Healthcare Insurance company local to Philadelphia PA is looking to hire a Utilization Management Nurse (RN) to their delegation oversight & assessment ... PA RN license 2+ years of experience working in Utilization Review or Utilization Management with commercial payers or medicare/medicaid Experience/knowledge… more
- Adecco US, Inc. (Dallas, TX)
- We are currently seeking a ** Utilization Management Nurse ** in **Dallas, Texas** . If you want to join our team, apply today! We offer competitive salary ... in an acute care hospital setting required. + Minimum of two years Utilization Management acute care setting experience required. + Minimum of one year drafting… more
