Utilization Management RN SDH FMOL HealthUtilization Management RN SDHJackson, MSUnder broad direction from the Centralized Utilization Management Manager, is responsible for the hospital-wide Utilization Management Programs in a general acute care hospital which serves infant, pediatric, adolescent, young adult, adult and geriatric patients. Ensures that appropriate priority is given to provide high quality care by ensuring guidelines are followed for core measures through concurrent chart review and follow-up with appropriate healthcare provider.
NewUtilization Management Nurse Consultant CVS Health CorpUtilization Management Nurse ConsultantMS$26.01–$62.32 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
RN - Utilization Review - Utilization Review University of Mississippi Medical CenterRN - Utilization Review - Utilization ReviewJackson, MSPhysical and Environmental Demands: Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, no handling or working with potentially dangerous equipment, occasional working hours beyond regularly scheduled hours, occasional travelling to offsite locations, occasional activities subject to significant volume changes of a seasonal/clinical nature, occasional work produced is subject to precise measures of quantity and quality, occasional bending, occasional lifting/carrying up to 10 pounds, occasional lifting/carrying up to 25 pounds, no lifting/carrying up to 50 pounds, no lifting/carrying up to 75 pounds, no lifting/carrying up to100 pounds, no lifting/carrying 100 pounds or more, no climbing, no crawling, occasional crouching/stooping, no driving, occasional kneeling, occasional pushing/pulling, occasional reaching, frequent sitting, occasional standing, occasional twisting, and frequent walking. Job Summary: RN-Utilization Review is accountable to perform utilization management services for designated patient case load, including prospective, concurrent, retrospective, and denial management reviews by applying clinical protocols and review medical necessity criteria.
RN - Utilization Review - PT University of Mississippi Medical CenterRN - Utilization Review - PTJackson, MSPhysical and Environmental Demands: Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, no handling or working with potentially dangerous equipment, occasional working hours beyond regularly scheduled hours, occasional travelling to offsite locations, occasional activities subject to significant volume changes of a seasonal/clinical nature, occasional work produced is subject to precise measures of quantity and quality, occasional bending, occasional lifting/carrying up to 10 pounds, occasional lifting/carrying up to 25 pounds, no lifting/carrying up to 50 pounds, no lifting/carrying up to 75 pounds, no lifting/carrying up to100 pounds, no lifting/carrying 100 pounds or more, no climbing, no crawling, occasional crouching/stooping, no driving, occasional kneeling, occasional pushing/pulling, occasional reaching, frequent sitting, occasional standing, occasional twisting, and frequent walking. Job Summary: RN-Utilization Review is accountable to perform utilization management services for designated patient case load, including prospective, concurrent, retrospective, and denial management reviews by applying clinical protocols and review medical necessity criteria.
Utilization Review Surgery Nurse- RN Singing River Health SystemUtilization Review Surgery Nurse- RNOcean Springs, MississippiWork requires close visual and acuity and the ability to adjust the eye to bring an object into sharp focus, i.e. shift gaze from viewing a computer monitor to forms/printed material that are closer to compare data at close vision. Work involves using many physical motions in performing daily work activities; subject to exposure of body fluids, sputum and tissues, which may carry the hazard of infectious disease.
Director of Utilization Review University Health Services IncDirector of Utilization ReviewGulfport, MSThe Director of Utilization Review will assume responsibility for the functioning of the Utilization Review Department and provide utilization review services in a manner consistent with the philosophy and objectives of the facility; evaluates patient medical records to determine severity of patients illness and determines the appropriateness of level of care; serves as liaison for patients and hospital with insurance companies; negotiates and advocates for patient length of stay and level of care; oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital. Through its subsidiaries, UHS operates 29 acute care inpatient facilities, 346 behavioral health inpatient facilities and 168 outpatient and other facilities in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.
Care Review Clinician- Utilization Review (RN/LPN- Mississippi based- REMOTE) Molina Healthcare IncCare Review Clinician- Utilization Review (RN/LPN- Mississippi based- REMOTE)Jackson, MSRemoteResponsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Utilization Specialist Millcreek of MageeUtilization SpecialistMagee, MississippiFull 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 Specialist Acadia Healthcare Co IncUtilization SpecialistMSLICENSES/DESIGNATIONS/CERTIFICATIONS: ?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. ?Gather 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.
RN - Category Manager - Clinical Category Management/ Procurement University of Mississippi Medical CenterRN - Category Manager - Clinical Category Management/ ProcurementClinton, MSRequires occasional travelling to offsite locations, frequent activities subject to significant volume changes of a seasonal/clinical nature, constant work produced subject to precise measures of quantity and quality, occasional driving, occasional kneeling, occasional pushing/pulling, occasional reaching, frequent sitting, frequent standing, and frequent walking. Job Summary: Responsible for actively leading and supporting the UMMC department stakeholders, business managers, and value analysis teams in identifying and executing clinical strategic sourcing decisions designed to reduce operational expense, increase revenue, and improve patient outcomes.
Supervisor Case Management - RN FMOL HealthSupervisor Case Management - RNJackson, MSExperience, Education, Training, Special Skills, and Licensure: • 5 years clinical experience, plus 2 years in case management • Strong interpersonal, oral and written communication skills; computer skills; problem solving and critical thinking skills; time management and prioritization skills; leadership qualities including the ability to train, motivate, manage and supervise staff • Current Mississippi RN license • BLS. Clinical Expertise: Provides up to date clinical expertise to case management staff including new interventions and therapies, changes in clinical protocols and updates in clinical case management services in order to meet the needs of all assigned patient populations.
Director of Care Management - RN Community Health Systems IncDirector of Care Management - RNVicksburg, MSThe Director works collaboratively with staff, physicians, and community resources to deliver patient-centered care and achieve optimal outcomes. The Director, Care Management is responsible for overseeing the implementation, development, and management of the Care Management and Resource Management programs.
NewManager of Health Management (RN) Mississippi TelligenManager of Health Management (RN) MississippiMississippi, Mississippi5 years experience in a healthcare environment with demonstrated expertise in care management, care coordination, and/health care quality improvement, including experience with case management and evidence-based clinical guidelines; 3 – 5 years managing projects and/or a professional staff; Demonstrated experience working in a fast paced and deadline driven environment; Positions working on specific contracts may require U.S. Citizenship. If you need assistance to navigate Telligen’s careers website or to apply for a position, please send an email to [email protected] We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information.
Manager-Case Management RN Baptist Memorial Health Care CorpManager-Case Management RNJackson, MSAssumes accountability for the overall financial management of the department including but not limited to capital and operational budgeting, variance analysis as well as management of resources. Assists in creating a culture of optimism that focuses on serving as the patient's advocate, providing patient-centered care and prudent resource utilization.
Manager-Case Management RN Baptist Memorial Health CareManager-Case Management RNJackson, MSPreferred/Desired One year management Education Minimum Required: BSN Preferred/Desired: BSN or MSN Training: Minimum Required - None Preferred/Desired: Certified CM Special Skills Minimum Required: Critical thinking skills, communication, organization, interpersonal and computer skills. • Performs other duties as assigned while supporting the hospital and department’s mission, vision and values to enhance quality, utilization, service delivery and customer satisfaction Experience Minimum Requirements RN with 5 years of clinical experience in acute care nursing; 2 years of case management experience.
Transitional Care Management Nurse Singing River Health SystemTransitional Care Management NurseGulfport, MSLicense:** Currently licensed to practice in the State of Mississippi, License must be free of any encumbrances **Certifications:** Must be currently registered with the Mississippi State Board of Nurse Examiners **Experience:** Required: Must have (2) or more years direct patient care experience or clinic experience. Work requires close visual and acuity and the ability to adjust the eye to bring an object into sharp focus, i.e. shift gaze from viewing a computer monitor to forms/printed material that are closer to compare data at close vision.
Transitional Care Management Nurse - RN - Polulation Health Singing River Health SystemTransitional Care Management Nurse - RN - Polulation HealthPascagoula, MississippiIn this capacity, the role is designed to accomplish the following items for all three campus locations within SRHS: first line support of appointment dates and times given to the patients before discharge with a goal of 95%, completion of part 1 of the TCM phone call process with a goal of 90%, and provide applicable E&M codes to providers based on insurance coverage. Work requires close visual and acuity and the ability to adjust the eye to bring an object into sharp focus, i.e. shift gaze from viewing a computer monitor to forms/printed material that are closer to compare data at close vision.
Nurse-Navigator RN Baptist Memorial Health Care CorpNurse-Navigator RNJackson, MSProvide individual patient/family education and self-management support that is appropriate based on language, cognitive abilities, literacy level, learning style, cultural norms, patient preference, readiness for change, and resources available. Nurse-Navigator RN Job ID 39040 Job Category: Nurse RN Work Type: Full Time Work Schedule: Days Department: Oncology and Infusion Facility BMH Tipton Hospital Location: Memphis, TN.
Nurse-Navigator RN: Cancer Center Baptist Memorial Health Care CorpNurse-Navigator RN: Cancer CenterJackson, MSProvide individual patient/family education and self-management support that is appropriate based on language, cognitive abilities, literacy level, learning style, cultural norms, patient preference, readiness for change and resources available. Assist with and facilitate the transition of care from inpatient settings such as hospital, rehabilitation facilities and skilled nursing facilities to home.
Case Manager - RN FMOL HealthCase Manager - RNJackson, MSGraduate from an accredited school of nursing, RN Minimum of two years clinical experience required Case management or Utilization management experience preferred Employee must demonstrate ability to recognize patients individual needs based on medical conditions, age (infants, pediatrics, adolescents, young adults, middle-aged and geriatric), limitations and planned procedures Requires oral and written communication skills; professional affiliations Current Mississippi RN license required. Meets with treatment team to provide utilization review information, discusses issues pertaining to continued stay, discharge and aftercare plans, evaluates current financial resources, and discusses whether documentation reflects the need for continued stay and at what level of care is the most appropriate.
RN - Oncology - Ambulatory University of Mississippi Medical CenterRN - Oncology - AmbulatoryJackson, MSResponsibilities: In collaboration with the oncologist provides direct patient care, initial and ongoing assessment, patient education, management of chemotherapy effects, medicine reconciliation, and coordination of care of patients enrolled in protocols and clinical trials. Coordinates the operations of assigned clinical area including protocol and non-protocol chemotherapy regimens, calculating dosages and administering intravenous chemotherapy, patient scheduling, patient records, and patient admission for adult cancer patients.
RN - Oncology Ambulatory - Cancer Clinic University of Mississippi Medical CenterRN - Oncology Ambulatory - Cancer ClinicJackson, MSResponsibilities: In collaboration with the oncologist provides direct patient care, initial and ongoing assessment, patient education, management of chemotherapy effects, medicine reconciliation, and coordination of care of patients enrolled in protocols and clinical trials. Coordinates the operations of assigned clinical area including protocol and non-protocol chemotherapy regimens, calculating dosages and administering intravenous chemotherapy, patient scheduling, patient records, and patient admission for adult cancer patients.
NewRN Care-Coordinator, Division of Transplant and Hepatobiliary Surgery, SOM-Surgery University of Mississippi Medical CenterRN Care-Coordinator, Division of Transplant and Hepatobiliary Surgery, SOM-SurgeryJackson, MSParticipates in the control of cost effective services that reflect appropriate levels of staff, proper use of equipment, appropriate use of supplies, and effective management patient care. Demonstrates effective interviewing and assessment skills and integrates new or current techniques to obtain information from the resident/family to plan, implement, and evaluate patient care.
RN Neurosurgery Coordinator - Neurosurgery University of Mississippi Medical CenterRN Neurosurgery Coordinator - NeurosurgeryJackson, MSAttention to details, effective communication and documentation with numerous physician, operating room (or), intensive care unit (ICU), emergency department (ED), radiology, pathology, oncology, and anesthesiology staff, insurance companies, other health facilities, the patient and patient family. Reviews patient's medical care including lab and procedural results review, accurate maintenance of medication reconciliation, assessment of patient issues and triage care with providers, while demonstrating a complete commitment to the overall welfare of the patient.
RN Case Manager - PRN University of Mississippi Medical CenterRN Case Manager - PRNJackson, MSTime Type: Part time FLSA Designation/Job Exempt: Yes Pay Class: Salary FTE %: 100 Work Shift: Benefits Eligibility: Grant Funded Job Posting Date: 03/05/2026 Job Closing Date (open until filled if no date specified): Performs and documents a comprehensive assessment for a specified group of patients whose diagnosis; procedures; and social, psychological, or financial needs indicate they would benefit from case management.
Registered Nurse - Family Medicine University of Mississippi Medical CenterRegistered Nurse - Family MedicineJackson, MSParticipates in the control of cost effective services that reflect appropriate levels of staff, proper use of equipment, appropriate use of supplies, and effective management patient care. Demonstrates effective interviewing and assessment skills and integrates new or current techniques to obtain information from the resident/family to plan, implement, and evaluate patient care.
RN Case Manager I - Inpatient- PT University of Mississippi Medical CenterRN Case Manager I - Inpatient- PTJackson, MSProvides excellent customer service by collaborating with patients, families, providers, payers, and community resources, serving as a liaison to ensure seamless care transitions and maintaining current knowledge of available services and access criteria at the federal, state, and local levels. Knowledge, Skills, and Abilities: Demonstrates strong critical-thinking and prioritization skills to address patient clinical needs and support safe, timely transitions to post-acute care.
NewRN Care Coordinator - Orthopedics University of Mississippi Medical CenterRN Care Coordinator - OrthopedicsRidgeland, MSParticipates in the control of cost effective services that reflect appropriate levels of staff, proper use of equipment, appropriate use of supplies, and effective management patient care. Demonstrates effective interviewing and assessment skills and integrates new or current techniques to obtain information from the resident/family to plan, implement, and evaluate patient care.
NewRN - Complex Care Coordinator - Department of Pediatircs University of Mississippi Medical CenterRN - Complex Care Coordinator - Department of PediatircsJackson, MSParticipates in the control of cost effective services that reflect appropriate levels of staff, proper use of equipment, appropriate use of supplies, and effective management patient care. Demonstrates effective interviewing and assessment skills and integrates new or current techniques to obtain information from the resident/family to plan, implement, and evaluate patient care.
RN - Inpatient - Labor & Delivery - Full-Time/ Part-Time University of Mississippi Medical CenterRN - Inpatient - Labor & Delivery - Full-Time/ Part-TimeGrenada, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN I-Ambulatory-PRN University of Mississippi Medical CenterRN I-Ambulatory-PRNJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN Inpatient- Neurosurgery Intensive Care Unit- Full Time University of Mississippi Medical CenterRN Inpatient- Neurosurgery Intensive Care Unit- Full TimeJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN Inpatient- Neurosurgery Intensive Care Unit- PRN University of Mississippi Medical CenterRN Inpatient- Neurosurgery Intensive Care Unit- PRNJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN I-PRN-Health System Tiered - Surgical Suite-WH University of Mississippi Medical CenterRN I-PRN-Health System Tiered - Surgical Suite-WHJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN I - Adult Acute Care - Neurology/Neurosurgery - 4 South (Weekender) University of Mississippi Medical CenterRN I - Adult Acute Care - Neurology/Neurosurgery - 4 South (Weekender)Jackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patients condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Job Requisition ID: R00048338 Job Category: Nursing Organization: 4 South Location/s: Main Campus Jackson Job Title: RN I - Adult Acute Care - Neurology/Neurosurgery - 4 South (Weekender).
RN I - Adult Acute Care - Medical Surgical - 6 South (Weekender Dayshift) University of Mississippi Medical CenterRN I - Adult Acute Care - Medical Surgical - 6 South (Weekender Dayshift)Jackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN Inpatient- Bone Marrow Transplant Unit- Full Time/PRN University of Mississippi Medical CenterRN Inpatient- Bone Marrow Transplant Unit- Full Time/PRNJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN Inpatient- Children''''s of Mississippi- Cardiac Step-Down/ Post-op Unit- 5C- Full Time/ PRN University of Mississippi Medical CenterRN Inpatient- Children''''s of Mississippi- Cardiac Step-Down/ Post-op Unit- 5C- Full Time/ PRNJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN Inpatient- Cardiac Intensive Care Unit- Full Time/ PRN University of Mississippi Medical CenterRN Inpatient- Cardiac Intensive Care Unit- Full Time/ PRNJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN Inpatient- Children''''s of Mississippi- NICU- Full Time University of Mississippi Medical CenterRN Inpatient- Children''''s of Mississippi- NICU- Full TimeJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN Inpatient- Surgical Intensive Care Unit- Full Time/ PRN University of Mississippi Medical CenterRN Inpatient- Surgical Intensive Care Unit- Full Time/ PRNJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN Inpatient- Children''''s of Mississippi- NICU- PRN University of Mississippi Medical CenterRN Inpatient- Children''''s of Mississippi- NICU- PRNJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN Inpatient- Children''''s of Mississippi- Hematology/Oncology Unit- 3C- Full Time/ PRN University of Mississippi Medical CenterRN Inpatient- Children''''s of Mississippi- Hematology/Oncology Unit- 3C- Full Time/ PRNJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN Inpatient- Adult Emergency Department- Full Time University of Mississippi Medical CenterRN Inpatient- Adult Emergency Department- Full TimeJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN Inpatient- Mississippi Burn Center- Full Time/ PRN University of Mississippi Medical CenterRN Inpatient- Mississippi Burn Center- Full Time/ PRNJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
RN I-Ambulatory-Direct Care - Otolaryngology - FT University of Mississippi Medical CenterRN I-Ambulatory-Direct Care - Otolaryngology - FTRidgeland, MSProvides patient care by performing problem-focused assessments, planning, implementing and evaluating treatments and interventions for patients in the physicians practice. Ensures patients have access to care that is appropriate, safe, effective, timely, efficient, and equitable, resulting in optimal health states for patients and cost-effective outcomes for the practice and organization.
RN Patient Flow Coordinator-Discharge Lounge University of Mississippi Medical CenterRN Patient Flow Coordinator-Discharge LoungeJackson, MSJob Summary: Maintain direct control of hospital beds by actively managing patient discharges, following up promptly, and ensuring discharged patients are consistently and quickly removed from the EHR for timely bed reassignment. Encourage and facilitate discharges prior to noon to optimize patient flow and ensure timely bed availability.
RN I - Ambulatory - Transplant Clinic University of Mississippi Medical CenterRN I - Ambulatory - Transplant ClinicJackson, MSActively engages in practice and organizational initiatives that create and maintain an internal environment that is safe, hazard-free, ergonomically correct, confidential, and comfortable for patients, visitors, and staff. Ensures patients have access to care that is appropriate, safe, effective, timely, efficient, and equitable, resulting in optimal health states for patients and cost-effective outcomes for the practice and organization.
NewRN I-Inpatient University of Mississippi Medical CenterRN I-InpatientJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.
NewRN I-PRN-Health System Tiered University of Mississippi Medical CenterRN I-PRN-Health System TieredJackson, MSEducates patients (and possibly family members) on topics such as the nature and status of patient's condition, diet and associated side effects of medication/treatments and the importance of complying with medication schedules. Provides patient care by assessing, planning, implementing and evaluating treatments and interventions for patients.