UNKNOWN

FEED

At least 12 years of health care experience, including at least 10 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or special programs, or equivalent combination of relevant education and experience, or equivalent combination of relevant education and experience. Identifies and reviews new products to enhance care service delivery, safety net planning, development of alternative levels of care (with anticipated improved outcomes with cost offsets), predictive modeling, integration with medical care management, or other approaches that support the patient centered medical home.

YEAR

Molina Healthcare Inc.

VP, Healthcare Services (Nevada)

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Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members. Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.

HOUR

Knight Health Holdings LLC

Regional Resource Case Manager Full Time

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Registered Nurse (RN), Nursing, Home Care Registered Nurse, Emergency Room Registered Nurse, Clinical Nurse, Nurse Case Manager, Field Case Manager, Medical Nurse Case Manager, Workers' Compensation Nurse Case Manager, Critical Care Registered Nurse, Advanced Practice Registered Nurse (APRN), Nurse Practitioner, Case Management, Case Manager, Home Healthcare, Clinical Case Management, Hospital Case Management, Occupational Health, Patient Care, Utilization Management, Acute Care, Orthopedics, Rehabilitation, Rehab, CCM, Certified Case Manager, CDMS, Certified Disability Management Specialist, CRC, Certified Rehab Certificate, CRRN, Certified Rehab Registered Nurse, COHN, Certified Occupational Health Nurse, CMC, Cardiac Medicine Certification, CMAC, Case Management Administrator Certification, ACM, Accredited Case Manager, MSW, Masters in Social Work, URAC, Vocational Case Manager. As a Field Case Manager, you will work closely with treating physicians/providers, employers, customers, legal representatives, and the injured/disabled person to create and implement a treatment plan that returns the injured/disabled person back to work appropriately, ensure appropriate and cost-effective healthcare services, achievement of maximum medical recovery and return to an optimal level of work and functioning.

Enlyte Group LLC

Medical Field Case Manager

FULL_TIME

Registered Nurse (RN), Nursing, Home Care Registered Nurse, Emergency Room Registered Nurse, Clinical Nurse, Nurse Case Manager, Field Case Manager, Medical Nurse Case Manager, Workers’ Compensation Nurse Case Manager, Critical Care Registered Nurse, Advanced Practice Registered Nurse (APRN), Nurse Practitioner, Case Management, Case Manager, Home Healthcare, Clinical Case Management, Hospital Case Management, Occupational Health, Patient Care, Utilization Management, Acute Care, Orthopedics, Rehabilitation, Rehab, CCM, Certified Case Manager, CDMS, Certified Disability Management Specialist, CRC, Certified Rehab Certificate, CRRN, Certified Rehab Registered Nurse, COHN, Certified Occupational Health Nurse, CMC, Cardiac Medicine Certification, CMAC, Case Management Administrator Certification, ACM, Accredited Case Manager, MSW, Masters in Social Work, URAC, Vocational Case Manager. As a Field Case Manager, you will work closely with treating physicians/providers, employers, customers, legal representatives, and the injured/disabled person to create and implement a treatment plan that returns the injured/disabled person back to work appropriately, ensure appropriate and cost-effective healthcare services, achievement of maximum medical recovery and return to an optimal level of work and functioning.

Enlyte

[AW]-iCims

You will collaborate closely with hospitalist physicians, nurses, specialists, pharmacists, case managers, social workers, and other clinical partners to deliver timely, coordinated care in accordance with state scope-of-practice requirements, hospital policies, and granted clinical privileges. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients.

CenterWell

Daytime Hospitalist APP

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Join Encompass Health, where being a Case Manager goes beyond just a job; it positions you as a vital link between exceptional care and the transformative impact on each patient's journey. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For Award, among other accolades, which is nothing short of amazing.

Encompass Health Corp.

Case Manager

Knowledge of: Reimbursement and coding methodologies and guidelines; MS-DRGs, APR-DRGs; Severity of Illness, Risk of Mortality, Medical Necessity, Core and Quality Measures and impact of Length of Stay; HACs/PSIs; supervisory principles and practices; disease pathophysiology and drug utilization clinical documentation improvement and coding; department and hospital safety practices and procedures; patient rights; infection control policies and practices; handling, storage, use and disposal of hazardous materials; department and hospital emergency response policies and procedures; age specific care practices. Option 2: Certification in one of the following: Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA), issued by the American Health Information Management Association, Certified Professional Coder (CPC), Certified Professional Coder-Physician-based (CPC-P), and one of the following: Certified Document Improvement Practitioner (CDIP), Certified Clinical Documentation Specialist (CCDS), Certified Clinical Documentation Specialist-Outpatient (CCDS-O).

Global Force USA

Clinical Documentation Improvement (CDI) Manager

OTHER

Functions as an advocate for the beneficiary by ensuring access to necessary care and maintaining Beneficiary's safety, locating specialized services outside the network by identifying providers, exploring nature of services offered, and facilitating process. Independent Thinking / Self-Initiative: Resourceful critical thinker who is able to prioritize tasks essential to achieving desires outcomes, demonstration a proactive commitment to task completion and the ability to identify and secure necessary resources.

TriWest Healthcare Alliance

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In support of TRICARE beneficiaries enrolled in the Autism Care Demonstration (ACD), the Autism Services Navigator (ASN) collaborates and oversees the assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services for TRICARE beneficiaries diagnosed with autism spectrum disorder (ASD). • Current unrestricted licensure in an appropriate state or territory of the United States, as a Licensed Independent Clinical Social Worker (LICSW), Licensed Clinical Social Worker (LCSW), Registered Nurse, or other licensed mental health professionals who possess a Certification in Case Management (CCM).

Autism Services Navigator

This role ensures safe, efficient, and high-quality patient care while managing staff performance, departmental processes, and resource utilization. The PACU Manager is a working leader responsible for overseeing the daily operations of the post-anesthesia care unit.

Tribal Health

PACU Manager

Broadbean

Communicates with and supports physician reviewers by summarizing case facts, preparing case questions, and resolving physician input issues. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.

DOMA Technologies

Clinical Review Coordinator (NEW)

PART_TIME

Working alongside the VPMA, Provider Engagement Managers, Affiliate Practices, care management and other P3 Clinical Programs; this role identifies members with repeat inpatient admissions, assembles the clinical picture for weekly interdisciplinary review, translates that review into a clear plan, and delivers it directly to the primary care physician who can act on it. Conduct direct outreach to members in the cohort following an inpatient or emergency department admission, and connect them to a primary care appointment and to the P3 programs that fit their needs.

P3 Health Group Management,LLC

Healthcare Program Manager

Director of Clinical Services, Home Health Director of Nursing, Home Health Clinical Director, Registered Nurse (RN), Clinical Operations Management, Home Health Care Management, Quality Assurance and Performance Improvement (QAPI), Medicare and State Regulatory Compliance, Clinical Staff Supervision and Development, Patient Care Coordination. Excellent interpersonal skills necessary in order to communicate effectively with a wide variety of personnel when identifying and resolving sensitive and complex patient or administrative issues.

LifeCare Home Health Family

Director of Clinical Services, Home Health

The Transition of Care Coordinator provides clinical oversight and coordination for beneficiaries moving between levels of care, supports discharge planning, conducts post-discharge follow up, completes assessments and reassessments as needed, identifies barriers to care, and reviews and processes authorization and referral requests according to policy. Technical Skills: Thorough knowledge of internal policies and procedures, utilization management principles, managed care concepts, medical terminology, and medical management system, clinical decision support tools, International Classification of Diseases, and Current Procedural Terminology.

Transition of Care Coordinator RN/LCSW

Participate in IDDRs presenting GMLOS, ALOS, anticipated discharge plan, and discharge barriers Drive progression of care utilizing evidence based clinical guidelines (i.e., InterQual) Facilitate a discharge plan based on clinical needs and resources (e.g., wound vac) Ensures post-acute referrals are entered in EMR Discharge plan is in place and documented in EMR Choice forms are obtained as needed IMMs are signed 48 hours prior to DC Ensures all are in agreement with discharge plan, date of discharge, and plan for care transitions Reviews EMR and ensures when appropriate: DME orders entered and Face to Face documentation (as applicable) is done DC summaries are written and in system in time for discharge All tests are scheduled timely and escalate as needed (Lab, Imaging, Surgery) LOS does not extend beyond calculated GMLOS and ensure everyone on care team is working towards timely discharge. Clinically complex cases are worked up appropriately for discharge needs (wound vac, IV meds, Meds Requiring Pre Approval, etc.) Incumbent must respect beliefs and values while advocating for the clients right to self-determination and to make informed choices.

Renown Health

Case Manager (Maternal Child)

The Site Director works in collaboration with the Director, Operations & Clinical Coordinator, faculty, staff, Fallon campus leadership, healthcare partners, and community stakeholders to support student success, workforce development, program quality, and responsive rural healthcare education pathways. The Site Director oversees Fallon campus instructional and operational activities, including faculty supervision and development, local clinical coordination, student support, community partnerships, and oversight of facilities and on-site clinical partnerships.

Western Nevada College

Site Director, Nursing & Allied Health - Fallon

If you're an experienced RN leader who builds strong teams, takes compliance seriously, and wants a real seat at the table in shaping how an agency grows, this role is for you. Excellent interpersonal skills necessary to communicate effectively with various personnel when identifying and resolving sensitive and complex patient or administrative issues.

Director of Patient Care

About Us We are a confidential healthcare organization providing managed-care and pharmacy review services across the U.S. Our pharmacists ensure the right medication reaches the right patient at the right time. Remote Clinical Review Pharmacist – Work From Home | Evidence-Based Decisions | Flexible Schedule Leverage your clinical knowledge in a fully remote Clinical Review Pharmacist role.

Utilization Management Nurse Jobs in Nevada

VP, Healthcare Services (Nevada) Molina Healthcare Inc.

Regional Resource Case Manager Full Time Knight Health Holdings LLC

Medical Field Case Manager Enlyte Group LLC

Medical Field Case Manager Enlyte

Daytime Hospitalist APP CenterWell

Case Manager Encompass Health Corp.

Clinical Documentation Improvement (CDI) Manager Global Force USA

Case Manager TriWest Healthcare Alliance

Autism Services Navigator TriWest Healthcare Alliance

PACU Manager Tribal Health

Clinical Review Coordinator (NEW) DOMA Technologies

Healthcare Program Manager P3 Health Group Management,LLC

Director of Clinical Services, Home Health LifeCare Home Health Family

Transition of Care Coordinator RN/LCSW TriWest Healthcare Alliance

Case Manager (Maternal Child) Renown Health

Case Manager Renown Health

Site Director, Nursing & Allied Health - Fallon Western Nevada College

Director of Patient Care LifeCare Home Health Family

Remote Clinical Review Pharmacist Pharmacy Careers

Program Manager P3 Health Partners LLC

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