- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Veterans Affairs, Veterans Health Administration (Salisbury, NC)
- … program. Responsibilities The Registered Nurse ( Utilization Management ) possesses intimate knowledge of InterQual review criteria, utilization ... Summary The Registered Nurse ( Utilization Management ) is...staff, patient flow coordinators, social workers, transfer coordinators, and Utilization Review nurses. Provides timely feedback regarding… more
- Centene Corporation (Phoenix, AZ)
- … utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines + Monitors ... remote position.** **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
- Albany Medical Center (Albany, NY)
- …of America) Salary Range: $78,773.63 - $122,099.12 Under direction of the Manager of Utilization Management , the Utilization Management Specialist is ... Bachelor's Degree in a Health-related field is required. + Registered nurse with a New York State...setting with at least two years in case or utilization management . Skills and Knowledge: + Knowledge… more
- Crouse Hospital (Syracuse, NY)
- …and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse ( RN ) to track and manage data ... (typically requires 6 weekends a year). Utilization Management Registered Nurse ( RN...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… more
- Ascension Health (Nashville, TN)
- **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40 hours a week. + **Hospital:** Ascension Saint Thomas + **Location:** ... TN market. We're looking for an experienced Director of Utilization Management to join our team! In...all clients. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Tennessee Board… more
- Intermountain Health (Las Vegas, NV)
- …FEHB, Marketplace Qualified Health Plans, fully funded and self-funded Commercial plans. Utilization Review nurses at Select Health proactively oversee inpatient ... in care management /navigation or closely related field including: Utilization Management , discharge planning, managed care, health promotion, health… more
- AmeriHealth Caritas (Newtown Square, PA)
- …**Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity ... efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will...in Nursing (BSN) preferred. + An active compact state Registered Nurse ( RN ) license in… more
- University of Virginia (Charlottesville, VA)
- …can assist with the management of payer initiatives or assist with Utilization Review Committee related items. The Manager provides effective leadership to ... The Utilization Management Manager is primarily responsible...nursing experience required **Licensure:** Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia… more
- CVS Health (Indianapolis, IN)
- …operation. Work schedules may include weekends and holidays and evening rotations._ As a Utilization Management Nurse Consultant you will be responsible for ... **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care... RN licensure in state of residence + Utilization Management is a 24/7 operation and… more