Travel Nurse RN - Care Manager - $2,443 per week Talent4HealthTravel Nurse RN - Care Manager - $2,443 per weekNew York, NYTalent4Health, based in Wilmington, DE is a one stop solution that offers access to an inclusive network of excellent healthcare professionals through its state-of-the-art recruitment strategies and extensive career opportunities. Proficiency : Our seasoned team of professionals has years of experience and we are dedicated to provide the highest quality service to our clients and candidates.
UM Review Nurse - LVN Astrana Health IncUM Review Nurse - LVNMonterey Park, CARemoteIn this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. We are seeking nurses with at least one year of outpatient UM experience in a fast-paced setting.
Manager, Medical Review (Medicare - Appeals; Utilization Review; Part A; HHH) CGS AdministratorsManager, Medical Review (Medicare - Appeals; Utilization Review; Part A; HHH)Nashville, TennesseeWe are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. Required Licenses and Certificates: Active RN licensure in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).
Manager, Medical Review (Medicare - Appeals; Utilization Review; Part A; HHH) BlueCross BlueShield of South CarolinaManager, Medical Review (Medicare - Appeals; Utilization Review; Part A; HHH)Nashville, TennesseeWe are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. Required Licenses and Certificates: Active RN licensure in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).
Utilization Management Clinical Reviewer TriWest Healthcare AllianceUtilization Management Clinical ReviewerLas Vegas, NVRemoteFull timeApplies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.
Utilization Management Nurse (RN) (Temporary) Central California Alliance for HealthUtilization Management Nurse (RN) (Temporary)San Jose, CARemote$52–$57.50 / hourAssociate's degree in Nursing and a minimum of five years of experience in a patient care setting which included a minimum of one year of experience in Utilization Management or Case Management (a Bachelor's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).
NewSupervisor, Utilization Management Medicare And Duals (One Care And Sco) Brigham and Women's HospitalSupervisor, Utilization Management Medicare And Duals (One Care And Sco)Somerville, MARemote$99,465.60–$144,643.20 / yearWorking with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success.
Utilization Specialist - Full Time The Camp Recovery CenterUtilization Specialist - Full TimeScotts Valley, California$25–$27 / hourFull timeGather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office. Preferred Licensure : LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
Utilization Management Clinical Consultant Integrated Resources, IncUtilization Management Clinical ConsultantDowners Grove, IllinoisFull timeRN or LCSW only) Job Description: Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. • Managed care/utilization review experience preferred Education and Certification Requirements Licensed independent Behavioral Health clinician in state of service or a Registered Nurse (RN) with unrestricted state license.
NewTravel Nurse RN - Case Manager - $2,100 to $3,300 per week in Greenbrae, CA job.comTravel Nurse RN - Case Manager - $2,100 to $3,300 per week in Greenbrae, CAGreenbrae, CA$2,100–$3,300The RN Case Manager will work closely with physicians, nurses, and interdisciplinary teams to manage patient care plans, review medical necessity, and ensure efficient use of healthcare resources. This role involves coordinating patient care, performing utilization review, and ensuring appropriate care planning within an acute care hospital environment.
NewTravel Nurse RN - Case Manager - $2,600 to $2,700 per week in Walnut Creek, CA job.comTravel Nurse RN - Case Manager - $2,600 to $2,700 per week in Walnut Creek, CAWalnut Creek, CA$2,600–$2,700The RN Case Manager will coordinate comprehensive patient care plans, facilitate safe and timely discharges, and collaborate closely with physicians and interdisciplinary teams to ensure optimal patient outcomes. We are seeking an experienced Travel Registered Nurse (RN) – Case Manager to join a fast-paced acute care hospital team.
Registered Nurse Supervisor 1 Psychiatric (NY HELPS), Hutchings Psychiatric Center, Nights, P27102 New York State Thruway AuthorityRegistered Nurse Supervisor 1 Psychiatric (NY HELPS), Hutchings Psychiatric Center, Nights, P27102Syracuse, NY$113,178–$124,230 / yearDue to the December 22, 2022 title structure change, permanent competitive or 55-b/55-c service in the following titles is also qualifying: Community Mental Health Nurse and all parenthetics, Community Nursing Services Consultant (Developmental Disabilities), Community Nursing Services Consultant (Home Health Services), Community Nursing Services Consultant (Mental Health), Health Services Nurse, Hospital Nursing Services Consultant, Infection Control Nurse, Medical Care Representative, Nurse 1 and all parenthetics, Nurse 2 and all parenthetics, Nurse 3 and all parenthetics, Teaching & Research Center Nurse 1, Teaching & Research Center Nurse 2, Teaching & Research Center Specialty Nurse, or Senior Utilization Review Nurse. If appointed, you may be required to become an enrolled Medicare provider; obtain and provide to your employer a National Provider Identifier (NPI) number issued by the National Plan and Provider Enumeration System (NPPES); and otherwise actively participate to the degree necessary to allow for your services to be billed through Medicare and Medicaid.
Registered Nurse Supervisor 1 Psychiatric (NY HELPS), Hutchings Psychiatric Center, Evenings, P27101 New York State Thruway AuthorityRegistered Nurse Supervisor 1 Psychiatric (NY HELPS), Hutchings Psychiatric Center, Evenings, P27101Syracuse, NY$113,178–$124,230 / yearDue to the December 22, 2022 title structure change, permanent competitive or 55-b/55-c service in the following titles is also qualifying: Community Mental Health Nurse and all parenthetics, Community Nursing Services Consultant (Developmental Disabilities), Community Nursing Services Consultant (Home Health Services), Community Nursing Services Consultant (Mental Health), Health Services Nurse, Hospital Nursing Services Consultant, Infection Control Nurse, Medical Care Representative, Nurse 1 and all parenthetics, Nurse 2 and all parenthetics, Nurse 3 and all parenthetics, Teaching & Research Center Nurse 1, Teaching & Research Center Nurse 2, Teaching & Research Center Specialty Nurse, or Senior Utilization Review Nurse. If appointed, you may be required to become an enrolled Medicare provider; obtain and provide to your employer a National Provider Identifier (NPI) number issued by the National Plan and Provider Enumeration System (NPPES); and otherwise actively participate to the degree necessary to allow for your services to be billed through Medicare and Medicaid.
Utilization Mgmt LPN/24/NUR130 Judge GroupUtilization Mgmt LPN/24/NUR130Mendota, MNRemote$16–$17 / yearBy providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. The Utilization Management LPN supports daily UM operations by performing timely and accurate authorization reviews, ensuring compliance with regulatory and health plan requirements, and maintaining workflow efficiency.
Utilization Mgmt Nurse RN Judge GroupUtilization Mgmt Nurse RNPearland, TXRemote$38–$39 / yearBy providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. The Acute / Post-Acute UM Nurse plays a crucial role in supporting inpatient utilization management processes.
Pt Transition Utilization Coordinator, Full Time, Days/Weekends Summit Healthcare AssociationPt Transition Utilization Coordinator, Full Time, Days/WeekendsShow Low, AZPart timeThis position requires knowledge of general office equipment (including the nurse call system, telephone system, fax machine, copy machine, computer, and commonly used hospital programs) as well as excellent computer, communication, critical thinking, problem solving, leadership, supervisory, interpersonal skills, basic math skills, and the ability to exercise independent judgment. The coordinator assists with identifying and anticipating discharge needs for assigned patients and communicates and collaborates with the interdisciplinary team through verbal and written communications while maintaining strict confidentiality specific to communication, record keeping and coordination of services.
Director of Utilization Acadia Healthcare Co IncDirector of UtilizationEl Paso, TXLICENSES/DESIGNATIONS/CERTIFICATIONS: If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services. Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.
Nurse Reviewer - Itemized Bill Review Gainwell Technologies LLCNurse Reviewer - Itemized Bill ReviewTX$78,000–$85,000 / yearGainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits. Active, unrestricted RN license in the United States and in the primary state of residence; active compact multistate RN license as defined by the Nurse Licensure Compact (NLC) required.
Utilization Management Professional, Integrated Resources, IncUtilization Management Professional,Miami, FloridaFull timeOur team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. The manager is looking for 3 years of Inpatient Medical experience, 3 years of Utilization experience, Concurrent Review experience and HMO exp.
Utilization Mgmt Coord - Behavioral Health, PRN, Macon Piedmont Healthcare Inc.Utilization Mgmt Coord - Behavioral Health, PRN, MaconMacon, GeorgiaPer diemThis role ensure that patient's payor has the clinical information with which to authorize the behavioral health service and continued stay service to include covered days and associated services. This role ensure that patient's payor has the clinical information with which to authorize the behavioral health service and continued stay service to include covered days and associated services.