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Supervisor Utilization Management Rn Jobs in Bee, Texas

Rn Utilization Management Nurse 2 - Se Region - Remote
By Humana At , , Tx
2 or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment
Rn Supervisor Jobs
By Touchstone Communities At Helotes, TX, United States
Competitive compensation and benefit package
Make Lives Better. Be a part of something meaningful: The Touchstone Experience.
A place where your voice matters
Accrue paid time off starting day 1
Touchstone Emergency Assistance Foundation Grants
Registered Nurse Supervisor - Weekends
Rn Supervisor Jobs
By Touchstone Communities At Hondo, TX, United States
Competitive compensation and benefit package
Make Lives Better. Be a part of something meaningful: The Touchstone Experience.
A place where your voice matters
Accrue paid time off starting day 1
Touchstone Emergency Assistance Foundation Grants
Heres whats in it for YOU!
Rn Utilization Management Reviewer
By Commonwealth Care Alliance At , Boston, 02108
3+ years combined clinical and utilization management experience
Experience with utilization management platform preferred
Knowledge, Skills & Abilities Required:
Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy
3+ years' experience working in a health plan preferred
Strong collaboration and negotiation skills
Rn Coordinator Utilization Management (1.0 Fte)
By Network Health At , Menasha, 54952
Provides education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff.
Experience in insurance, managed care and utilization management preferred.
Participates in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files).
Supports Utilization Management department programs and goals through active participation.
Identifies and screens candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria.
Performs other duties and responsibilities as assigned.
Rn Utilization Management Nurse Cst Est Location Remote
By Optum At , Atlanta, 30319
Experience in utilization review and/or utilization management
Collaborate with UnitedHealthcare Medical Directors on performing utilization management
Follow all Standard Operating Procedures in end-to-end management of cases
Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities
Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
Identify delays in care or services and manage with MD
Rn Supervisor Jobs
By NaphCare, Inc. At , Atlanta
NaphCare Benefits for part time employees include:
Coordinate, structure, implement and guide the delivery of the nursing service program within the facility
Take and document all patient history and vital signs
Assist with daily triage/sick call, minor medical/surgical procedures and patient assessments
Assist with examinations and/or treatments
Assist in evaluating the quality and effectiveness of clinical services
Utilization Management Rn Jobs
By Children's Health At , Dallas, 75390, Tx
Accountable for current knowledge of utilization management responsibilities, including: payer information; business rules; regulatory guidelines; and policies and procedures.
At least 1 year Utilization Review or Case Management experience Preferred
Escalate payer problems to UM RN II or Denials Management Specialist
Identifies issues and strategies to modify and/or enhance the utilization management program.
Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification Preferred
Maintains productivity and optimum case load, delegating appropriately to maximize skills set, productivity and effectiveness.
Rn Utilization Management Jobs
By Ascension At , Bulverde, 78163, Tx From $69,555 a year
Department: Ascension Care Management Insurance
Provide case management and/or consultation for complex cases.
Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
BSN with at least 3 years of nursing experience
Health plan or inpatient utilization experience
Utilization Management Rn Jobs
By Boston Children's Hospital At , Boston, 02115, Ma
Minimum 3-5 years of related Case Management or clinical experience.
Connecting with UM Case Manager on the concurrent side for any questions of consistency.
Conducting proactive education on the importance of level of care/patient class
Leading physician education efforts to inform level of care decisions
A BSN is required, a Master’s in a related Healthcare field or certification is a plus.
The Case Manager will be responsible for:
Rn - Utilization Management Nurse 2 - Remote - Florida Region
By Humana At , Atlanta, 30338, Ga
3+ year experience in Utilization Management with Medicare and/or Medicaid guidelines.
Prior clinical experience in an acute care, skilled or rehabilitation clinical setting.
Excellent computer and communication skills.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Utilization Management Rn Jobs
By Piedmont Healthcare At , Atlanta, Ga

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:

Forbes named Piedmont one of Georgia’s 10 best employers and the highest-ranked healthcare provider.

Rn Supervisor Jobs
By Valley Staff VHS Physician Svcs At , Harlingen, Tx
3+ years of leadership experience in practice management of multiple locations or multi specialty (required)
Manage the revenue cycle component of mutiple service lines and assist staff with barries to billing.
5+ years of relevant clinical operations experience as a case manger, floor unit nurse ( required)
You will identify opportunities for improvement and innovation, removes barriers and resistance.
You will collaborate effectively with Division service line leaders and hospital business development leaders
You will proactively identify practice/business development opportunities to increase market share
Rn Utilization Management Reviewer
By Commonwealth Care Alliance At , Boston, 02108, Ma
3+ years combined clinical and utilization management experience
Experience with utilization management platform preferred
Knowledge, Skills & Abilities Required:
Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy
3+ years' experience working in a health plan preferred
Strong collaboration and negotiation skills
Rn, Utilization Management - Behavioral Health
By Humana At , Omaha, 68154, Ne
Utilization management experience, performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.
1 year of managed care experience working directly with insurance companies
Complete additional responsibilities as deemed appropriate by Humana leadership
Minimum 3 years of post-degree Clinical experience in direct patient care (either medical or behavioral health)
Adept experience working with computers, including proficiency with Microsoft Office products: Word, Excel and MS Teams and OneNote
Behavioral Health direct patient care experience preferred
Supervisor, Utilization Management - Medicare (Rn Or Licensed Behavioral Health Professional) - 015252
By Univera Healthcare At , Rochester, 14604, Ny
Applies project management skills by developing and implementing new initiatives.
Identifies strategies to improve health care resource management and communicates to internal and external customers.
Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
Performs other duties and functions as assigned by management.
Experience in interpreting health plan benefit plans
Basic familiarity with Managed Care legislation, NCQA, and Federal and State regulatory requirements
Rn, Utilization Management - Behavioral Health
By Humana At , Atlanta, 30338, Ga
Utilization management experience, performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.
1 year of managed care experience working directly with insurance companies
Complete additional responsibilities as deemed appropriate by Humana leadership
Minimum 3 years of post-degree Clinical experience in direct patient care (either medical or behavioral health)
Adept experience working with computers, including proficiency with Microsoft Office products: Word, Excel and MS Teams and OneNote
Behavioral Health direct patient care experience preferred
Supervisor, Utilization Management (Medicare) - 015252
By Excellus At , Rochester, 14604, Ny
Applies project management skills by developing and implementing new initiatives.
Identifies strategies to improve health care resource management and communicates to internal and external customers.
Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
Performs other duties and functions as assigned by management.
Experience in interpreting health plan benefit plans
Basic familiarity with Managed Care legislation, NCQA, and Federal and State regulatory requirements
Administrative Supervisor (Rn) Jobs
By University of Maryland Charles Regional Medical Center At , Easton, Md
Minimum three years current management experience.
MINIMUM EDUCATION, EXPERIENCE, AND LICENSE/CERTIFICATION REQUIRED:
Meets licensing requirements to practice registered nursing in the State of Maryland.
BSN preferred, certification in nursing specialty/nursing administration upon eligibility.
Health Care Provider BLS. Certification required.
6. Serves as coach and mentor for less experienced colleagues.
Utilization Review Rn (Prn Case Management) Montgomery Medical Center
By MEDSTAR HEALTH At , Olney, 20832, Md $35 - $50 an hour

Pay: $35.00 - $50.00 per hour