Utilization Management Nurse Jobs in the United States
Luminis Health
$34 - $55
ANNAPOLIS, MD
Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues. 2. Denial Management: Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken to avoid denial; assists Care Coordinator in communicating with the patient denied hospital days with work toward resolution and discharge.
Providence Health and Services
$52.26 - $81.13
Kirkland, WA
It is comprised of eight hospital campuses (Ballard, Edmonds, Everett, Centralia, Cherry Hill (Seattle), First Hill (Seattle), Issaquah and Olympia); emergency rooms and specialty centers in Redmond (East King County) and the Mill Creek area in Everett; and Providence Swedish Medical Group, a network of 190+ primary care and specialty care locations throughout the Puget Sound. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Providence Health and Services
$46.3 - $91.32
Olympia, WA
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers.
Williamson Health
Murfreesboro, TN
The flagship facility, Williamson Medical Center, which recently opened its new Boyer-Bryan West Tower, offers extensive women's services, state-of-the-art cardiology services, advanced surgical technologies, an award-winning obstetrics and NICU, leading-edge orthopaedics, outpatient imaging services, and distinct comprehensive emergency and inpatient services for both adult and pediatric patients. Timely reviews patients within 24 hours or next business day after admission and at a minimum of every 2 days thereafter for continued stay, applying appropriate criteria (Interqual®) and facilitating reimbursement for services with third payer parties, obtaining and entering authorization number/approval status and notes in Meditech.
Epitec, Inc
Albuquerque, NM
Knowledge, Skills, Abilities Required: • Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member. Essential Duties and Responsibilities: • Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies and compliance guidelines.
Nationwide Therapy Group
$1917
Torrance, CA
This includes offering exceptional pay packages along with these great benefits: Medical, dental, and vision insurance. NTG is committed to matching you to the right position and we pride ourselves on our commitment to our travelers.
Providence Health and Services
$44.16 - $77.58
Chugiak, AK
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The goal of the Inpatient Care Management RN is to ensure the use of appropriate healthcare resources throughout the continuum, so that the care provided is the right care, at the right time, in the right setting.
Providence Health and Services
$44.16 - $77.58
Jber, AK
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The goal of the Inpatient Care Management RN is to ensure the use of appropriate healthcare resources throughout the continuum, so that the care provided is the right care, at the right time, in the right setting.
Jobot
$115000 - $120000
New York, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Reporting to the Supervisor of Care Management this position will provide case management to our members including medical, social, psychological, physical, and spiritual needs by developing, implementing, and monitoring the care plan in.
Alderwood Manor
$52 - $58
Spokane, WA
Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Belen Meadows HC and Rehab Ctr
$40
Belen, NM
Facilitate a person-centered team approach to skin and wound prevention and management, working alongside nursing center leadership, nursing staff, physicians, therapists, dietitians, and families. As our Skin Health Team Lead, you will be a champion for skin integrity, working closely with our interdisciplinary team, patients, and their families to prevent and effectively manage skin and wound concerns.
Luminis Health
$40 - $60
Lanham, MD
Coordinate patients, equipment and staffing through effective planning and communication with the Charge Nurse and CSP for efficient case flow meeting targeted unit metrics. Contributes to the provision of high quality, cost-effective patient care and collaboration with other health care team members, with emphasis on designated service lines.
Providence Health and Services
$68.01 - $107.35
Everett, WA
The Manager RN Case Management is responsible for the daily management and organization of all activities and staff within the Case Management Department including care coordination, case management, discharge planning, utilization management, social work services, and pre-admission case management. The Manager acts as a liaison between patients and families, department staff, physicians and the healthcare team, community agencies, managed care representatives, skilled nursing facilities, and community agencies.
Life Care Center of Post Falls
$44.5 - $51.64
Post Falls, ID
Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Providence Health and Services
$43.29 - $76.06
Jber, AK
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, outreach programs, and hospice and home care. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Providence Health and Services
$44.16 - $77.58
Jber, AK
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The goal of the Inpatient Care Management RN is to ensure the use of appropriate healthcare resources throughout the continuum, so that the care provided is the right care, at the right time, in the right setting.
Providence Health and Services
$44.16 - $77.58
Anchorage, AK
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The goal of the Inpatient Care Management RN is to ensure the use of appropriate healthcare resources throughout the continuum, so that the care provided is the right care, at the right time, in the right setting.
ChristianaCare
$41.28 - $66.05
Wilmington, DE
ChristianaCare includes an extensive network of primary care and outpatient services, home health care, urgent care centers, three hospitals (1,336 beds), a freestanding emergency department, a Level I trauma center, and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women’s health. Incredible Work/Life benefits including annual membership to care.com, access to backup care services for dependents through Care@Work, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets and much more!
Mayo Clinic
Jacksonville, FL
The RN Case Manager bridges communication between providers, patients and families, members of the interdisciplinary team, and outside agencies to assure high-quality care that meets the patient’s needs and is delivered in a cost-effective and timely manner. The RN Case Manager utilizes the principles of mutual respect, patient/family advocacy and provides leadership within the team of internal partners and outside agencies to facilitate best practices that achieve quality clinical, financial, and patient satisfaction outcomes.
BoldAge PACE
$42 - $48
Fresno, CA
Provide coordination and direct care as indicated to promote continued care in the community or promote optimal institutional care (Assisted Living, Nursing Home, Hospital, etc.) as needed. Teach participants, caregivers and families about self-care, medications, healthy lifestyles, infection control and safety to promote optimal health and safety.
Providence Health and Services
$46.3 - $91.32
Tumwater, WA
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care.
Epitec, Inc
Nashville, TN
In this role, you will apply your clinical expertise to assess, plan, coordinate, and evaluate healthcare services that support positive member outcomes while ensuring cost?effective, high?quality care. This position manages a personal caseload, supports utilization management activities, and performs case management reviews across multiple settings.
Life Care Center of Lewiston
$37 - $40
Lewiston, ID
Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Providence Health and Services
$46.3 - $91.32
Olympia, WA
Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care. Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care.
TalentBurst, Inc.
$32 - $33
Orono, ME
2.4 Ensures timely and accurate compliance of the MDS process and that it reflects the patient's plan of care; 2.5 Participates with the interdisciplinary team in developing, implementing and evaluating ways to achieve patient goals and minimize rehospitalizations; 2.6 Ensures Point Click Care (PCC) is utilized according to the Business Processes; 2.7 Contacts attending physician to obtain orders as indicated (i.e., admission, change in condition, etc.); 2.8 Ensures that Physician Orders are followed as prescribed; 2.9 Oversees medication management to ensure adequate supplies and that all medications are handled in accordance Genesis policy; 2.10 Ensures that patient's attending physician and family or responsible party are promptly notified of any significant change in the patient's health condition; 2.11 Creates an environment that is respectful, team oriented and responsive to the concerns of staff, patients and families; 2.12 Ensures communication between licensed nursing staff and CNAs during and between shifts; 2.13 Participates in shift-to-shift communication between incoming and outgoing nursing staff; 2.14 Serves as a role model in the delivery of direct patient care using the nursing process; 2.15 Provides patient care when required; 2.16 Ensures discharge planning process is in place and provides consultation as needed; 2.17 Ensures complete and prompt reporting of incidents, accidents, and adverse events to Administrator and Director of Nursing. 4.1 Participates in the development, implementation and evaluation of quality improvement activities for the Center and/or unit as requested; 4.2 Prepares written reports, reviews records and participates in needed data collection as indicated; 4.3 Reviews clinical records of patients with unplanned rehospitalizations to identify areas in need of improvement; 4.4 Ensures that patient's accident/incident, adverse event and grievances/concerns are fully documented, investigated, reported and addressed in accordance with Genesis policies and procedures and the Federal/State rules and regulations; 5.
Envision Unlimited
Tinley Park, IL
Summary: The Medical Care Manager (MCM) is a member of the interdisciplinary team providing pre- and post-transition medical care management and clinical services to persons with mental or physical illness who are part of the Williams or Colbert Class Membership. Innovative services offered across Chicagoland and Central Illinois include community living options, novel day programs, behavioral health services, employment programs, respite for families, and foster care for children with disabilities.
Liberty Health
Greenville, NC
Must have a current, unrestricted Registered Nurse license in the state of assignment or the ability to obtain and submit proof of license renewal every other year. Completes assessment on members within 72 hours of discharge from ED, Hospital, SNF, or Home Health episode to ensure stability and continuity of care.
Greenlife Healthcare Staffing
Jericho, NY
Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a Non-profit organization located in New York. Soft Skills: Excellent written/verbal communication; ability to work independently; flexible and innovative; meets deadlines in sensitive environments; strong collaborative and problem-solving skills.
Jobot
$78000 - $90000
Lawrence, MA
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Contact: https://jobot.com/apply/rn-case-manager-hybrid-mon-fri-days/1184484381?utm_source=Monster
Life Care Center of Longmont
$35 - $46.08
Longmont, CO
Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Renaissance Park Multi Care Center
Benbrook, TX
Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours.
Mercy
$55000 - $66000
Springfield, MO
This position is designed to facilitate an effective process of the new care model; supporting quality patient care, safety, and financial components; promoting integration of a seamless care model; coordinating patient discharge planning for post-acute services, length of stay (LOS) management and utilization management; collaborating to include coordination as evidenced by metrics, optimizing performance and adoption of best practice. See Mercy Terms & Conditions at https://www.mercy.net/about/legal-notices/ and Privacy Policy at https://www.mercy.net/about/legal-notices/ and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.
Marmet Center
$86000
Marmet, WV
Responsibilities: The MDS Nurse -- RN manages the overall process and tracking of all Medicare/Medicaid case-mix documents to ensure appropriate reimbursement for all services provided within the nursing.*Maintain an accurate schedule of all MDS assessments to include the proper reference dates throughout the patient stay and ensures the accurate and timely submission of the MDS assessments including case-mix, OBRA and OSRA required assessments. *Serve as the nursing center resource for MDS/RUGs and state case-mix systems providing staff case-mix education and instruction on MDS terminology and format.
Mercy
$26.04 - $31.25
Joplin, MO
The Care Management model provides effective transition planning and length of stay oversight while encompassing quality patient care, patient safety, and financial components; promotes integration of a seamless care model; coordinates patient throughput; encourages healthcare team collaboration and coordination as evidenced by metrics; and optimizes performance and adoption of best practice. See Mercy Terms & Conditions at https://www.mercy.net/about/legal-notices/ and Privacy Policy at https://www.mercy.net/about/legal-notices/ and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.