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Utilization Management Resource Nurse Jobs

Resource Management Specialist Jobs
By Centers for Disease Control and Prevention At , Atlanta $104,008 - $135,209 a year
Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Emerging and Zoonotic Infectious Diseases
8/10/2023 12:00:00 AM to 8/21/2023 11:59:59 PM
CDC HELPDESK 1600 Clifton Road NE Atlanta GA US 30333
Internal to an agency - appears on USAJOBS, Career transition (CTAP, ICTAP, RPL)
Utilization Management Nurse - Pchp
By Parkland Health and Hospital System At , Dallas, 75201
Three years of experience in an acute clinical nursing or medical management setting.
Knowledge of utilization management and case management principles is preferred.
May have an equivalent combination of education and experience to substitute for the experience requirements.
Knowledge of NCQA, Federal and Texas Medicaid Utilization Management (UM) regulations.
Three years of managed care experience is preferred.
Provides appropriate consultation and referral to case management.
Manager, Utilization Management, Registered Nurse, Rn
By Humana At ,
Minimum 1 year Utilization Management Experience
Intermediate to advanced computer skills and experience with Microsoft Suite, Word, Excel, Outlook.
Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
Manager will travel twice a year to South Florida to attend meetings (See Additional Information below)
Minimum 1 year experience with any of the following Team Leadership, Project Leadership, or Subject Matter Expert, SME
Minimum 1-year progressive clinical experience preferably in an acute care clinical setting
Utilization Management Nurse Consultant
By CVS Health At , Arnold $28.25 - $60.50 an hour
2+ years of recent acute hospital clinical experience as an RN (recent defined as in the past 10 years).
Experience with all types of Microsoft Office including PowerPoint, Excel, and Word
Must have an active and unrestricted RN license
Utilization Management Nurse, Consultant
By Blue Shield of California At , Rancho Cordova, 95670 $109,120 - $163,680 a year
Previous experience in utilization management preferred
Working knowledge of regulatory and accreditation standards preferred (URAC, NCQA, DMHC, Case Management Society of America CMSA)
Requires a bachelor's degree or equivalent experience
Requires at least 7 years of prior relevant experience
Strong computer skills related to Windows-based programs and applications
Strong clinical documentation skills, independent problem identification and resolution skills
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
Utilization Management Nurse Consultant
By CVS Health At , $28.25 - $60.50 an hour
This candidate will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Weekend/holiday coverage will occasionally be required
Communicates with providers and other parties to facilitate care/treatment
Utilization Management Nurse Consultant
By CVS Health At , Opelousas $28.25 - $60.50 an hour
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
Identifies members who may benefit from care management programs and facilitates referral
Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
3+ years of clinical practice experience in an inpatient setting required
2+ years of experience as a Registered Nurse
Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
Utilization Management Nurse (Gulf South Region)
By Humana At , , Al
Experience in utilization management or related activities reviewing criteria to ensure appropriateness of care preferred
3-5 years of prior clinical experience preferably in an acute care hospital, skilled or rehabilitation clinical setting
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Excellent communication skills both verbal and written
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Previous Medicare experience a plus
Resource Management Specialist Jobs
By BDO USA At Houston, TX, United States
Qualifications, Knowledge, Skills and Abilities:
High proficiency in the use of Microsoft business products (Excel, PowerPoint, Word) including excellent data management and manipulation capabilities, preferred
Proficiency with PeopleSoft and OneStream, or experience with similar corporate management software, preferred
Other Knowledge, Skills & Abilities
Collaboratively engages with Resource Management counterparts to encourage resource sharing across regions, groups, etc.
Strong conflict resolution skills, including the abilities to negotiate and influence others
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
Home Health Utilization Management Nurse
By Humana At , , Tn
Previous experience in Case Management, Discharge Planning or Utilization Management
The Utilization Management Nurse 2/Home Health Utilization Management:
Clinical experience in Medicare Home Health (in the last 12 months)
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Previous Medicare/Medicaid Experience a plus
Utilization Management Registered Nurse
By Humana At , , Fl
Workstyle: Remote work at home
3-5 years acute care, (Medical Surgical, Heart, Lung or Critical Care), skilled or rehabilitation nursing experience
Previous hospital or health plan utilization management
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Education: BSN or Bachelor's degree in a related field
Utilization Management Nurse: Home Solutions
By Humana At , , Ky
Excellent organizational and time management skills
2 to 3 years of home health experience and/or utilization management experience
Experience in a managed care setting
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Solid analytical skills to understand and interpret data to make recommendations to improve patient care.
Collaboration skills to effectively interact with multiple parties both internal and external.
Utilization Management Nurse Jobs
By MFS Talent At Palo Alto, CA, United States
Maintain guidelines, federal and state regulations, payer requirements, and best practices related to utilization management.
Educate healthcare professionals and staff on utilization management principles, documentation requirements, and regulatory updates.
Case Management or Utilization Management certification or willingness to obtain within 2 years of hire.
Maintain accurate and thorough documentation of utilization management activities, including reviews, decisions, and interventions.
Identify opportunities for process improvement and participate in quality assurance activities related to utilization management.
Three (3) years of progressively responsible and directly related work experience, preferred.
Staff Nurse - Utilization Management - 100%
By University of Iowa At Iowa, United States
Previous experience with Utilization Management and/or Case Management is desired.
3-5 years of RN clinical nursing experience is required.
Excellent written and verbal communication skills are required.
Demonstrates excellent interpersonal skills with patients/families, nursing staff, and interdisciplinary team members as demonstrated through written and verbal interactions.
Previous experience performing Utilization Reviews in a RN capacity is recommended.
Previous experience involving high-volume public contact customer service is desired.
Utilization Management Nurse Jobs
By Campbell Healthcare Solutions At United States

The Utilization Management Nurse will use his/her professional judgment to evaluate the request and ensure that services are appropriately approved, recognize care coordination opportunities and refer ...

Resource Management Specialist Jobs
By Citrin Cooperman At United States
Minimum four years recent resource management or client services experience; preferably within a professional services firm or similar environment
Project Management experience a plus.
Utilize Resource Management systems to generate and analyze reporting documents
Maintain Resource Management tools such as Scheduling systems, email folders, Teams, etc.
Manage staffing allocation while working with the engagement teams to determine appropriate staffing and profitability
Act as the day-to-day contact for managers and staff regarding general firm and resource topics
Nurse Clinician - Level Of Care/Utilization Management - 100%
By University of Iowa At Iowa City, IA, United States
Participate in the development and implementation of disease-specific management programs with associated educational and clinical resources to support the patient/family/staff.
Demonstrated excellence in critical thinking, organizational skills, independent decision-making, time management, prioritization, and problem-solving skills
Develops & presents educational materials to inpatient units approved by the Nurse Manager.
Demonstrated experience in providing education to multiple stakeholders.
Experience and knowledge with Medicare Guidelines of outpatient observation and 2 midnight rule is desired.
Serves as an educational and clinical resource to clinics, patients, families, staff, and the community.
Utilization Management Nurse (Central Region)
By Humana At , Springfield, 65807, Mo
Utilization Management experience highly preferred
Prior clinical experience preferably in an acute care, hospital, skilled or rehabilitation clinical setting
Understands resources and role responsibilities as well as reporting structure
Follows established guidelines/procedures to ensure all work is compliant with CMS and NCQA requirements
2-5 years of acute care nursing experience
Comprehensive knowledge of Microsoft Word, Outlook and Excel