- Sharp HealthCare (San Diego, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... compliance with all local, state and federal regulations governing utilization review activities and/or care management...clinical experience as defined by the CBA. + California Registered Nurse ( RN ) - CA… more
- Centene Corporation (Madison, WI)
- … utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines + Monitors ... United States **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care...+ Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse -… more
- Centene Corporation (Atlanta, GA)
- … management principles preferred. Prior authorization preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Catholic Health Initiatives (Lexington, KY)
- …educational training for medical staff on issues related to utilization management . 8. Implements utilization review policies and procedures. 9. ... both inside our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director is responsible for the market(s) development,… more
- CareFirst (Baltimore, MD)
- …is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** +… more
- Point32Health (Canton, MA)
- …leading, and modifying the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, ... perform the job** **Education, Certification and Licensure** + Master's degree preferred. + RN ( Registered Nurse ) with unrestricted MA license preferred. +… more
- Fairview Health Services (St. Paul, MN)
- …role (grandfather status) + Current RN licensure in MN + 3-5 years utilization review or case management experience in hospital, clinic, insurance ... M Health Fairview has an immediate opening for a Utilization Management Specialist RN . This...care hospital nursing experience. + Excellent computer and database management skills. + Prior Utilization Review… more
- McLaren Health Care (Detroit, MI)
- …and implementing process improvement projects as needed. _Required:_ + State licensure as a registered nurse ( RN ) + Bachelor's degree in nursing from ... **Department: Utilization Management ** **Daily Work Times: 7:00am-3:30pm**...established SOP procedures. 4. Maintains current knowledge of hospital utilization review processes and participates in the… more
- Crouse Hospital (Syracuse, NY)
- Utilization Management Registered Nurse has...standard Utilization Review processes. The Utilization Management RN is an ... workload in a fast-paced, rapidly changing regulatory environment. The Utilization Management RN works collaboratively.../ LICENSURE + Required: + Currently licensed as a Registered Professional Nurse in New York State.… more
- CVS Health (Columbus, OH)
- …work the following schedule:** **Monday-Friday 8:00am-4:30pm EST.** **Position Summary** As a Utilization Management Nurse Consultant, you will utilize ... (Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** -1+ years' experience Utilization Review experience -1+ years' experience Managed Care -… more