A company is looking for a Case Manager - Utilization Management.Key ResponsibilitiesReview patient admissions to evaluate appropriateness and ensure compliance with third-party payer requirementsCollaborate with care managers and other departments to facilitate patient class assignments and maximize reimbursementParticipate in performance improvement processes to enhance departmental efficiency and effectivenessRequired QualificationsSpecialized Diploma in nursing2 years of previous utilization review experience2 years of knowledge of utilization management related to third-party payersRN - Licensed Registered Nurse in the state of Pennsylvania upon hireKnowledge of evidence-based clinical decision support criteria
Clinical Financial Case Manager - RN
A company is looking for a Clinical Financial Case Manager-RN. ...
Field Case Manager, LTSS (non-RN)
Opportunity open to TX LBSW, LMSW or LVN in the West Forth Worth service delivery area to work as a Field Case Manager with our Medicaid members there. Mileage is reimbursed as part of our benefits package. Develops and implements a case management plan, including a waiver service plan, in collabora...
Telephonic Case Manager RN
A company is looking for a Telephonic Case Manager RN in Transplant Medicine to provide care coordination and support to members. ...
Lead RN Case Manager
The Lead RN Case Manager is responsible for supervising a team of RN Case Managers in the inpatient and emergency departments at all NCH campuses. The Lead RN Case Manager will enforce departmental policies, provide mentorship to RN Case Managers, and collaborate with multi-disciplinary teams to ens...
Remote RN Case Manager - NC License
Key Responsibilities:Collaborate with a healthcare team to monitor utilization patterns and facilitate appropriate healthcare deliveryConduct comprehensive assessments of members' health status, including medical records and clinical historyWork with healthcare providers and family members to develo...
Case Manager RN- Field
Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Monitoring, Evaluation and Documentation of...
Complex Case Manager RN - Oncology (Remote)
In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in...
Utilization Management Nurse Consultant - Special Case Precertification Unit (Remote)
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. CVS H...
RN Case Manager
Gabriel's Hospice and Palliative Care is dedicated to providing compassionate and comprehensive care to patients with serious, chronic, or terminal illnesses. Initial and ongoing comprehensive assessments of the impact of the terminal disease on the patients physical, functional, psychosocial, and e...
Nurse Case Manager - Inpatient Utilization Review
Our goal is to provide high quality, compassionate clinical care for every patient, every time. Everyone who wears the JPS badge contributes to our journey to excellence. Every day, every shift, we celebrate our patients, smile, and emphasize positivity. Smiling, laughter, compassion - key component...