Top 6296 Rn Utilization Manager Jobs

RN Team Lead Utilization Review
MedStar Health —Clinton, MD
- $89,065 - $162,801 a year
- Full-time
- Nursing
- RN License
- Inpatient
7d
RN Case Manager - Surgery Services
UCLA Health —Los Angeles, CA
- $65.53 - $88.99 an hour
- Nursing
- Surgery
- RN License
Utilization Review RN - FT - Day - Utilization Resource Management Trenton NJ
Capital Health —Trenton, NJ
- $39.40 - $51.47 an hour
- 8 hour shift
- Nursing
- RN License
- Discharge planning
- AD&D insurance
- Disability insurance
RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
Nurse Case Manager, Utilization Management
1199SEIU Family of Funds —New York, NY
- $89,400 - $106,100 a year
- Full-time
- Nursing
- RN License
- Mid-level
RN Case Manager
Zócalo Health —Remote
- $85,000 a year
- Full-time
- Remote
- RN License
- Writing skills
- Mid-level
- Health insurance
- Dental insurance
14d
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
RN Manager of Utilization Management
North Memorial Healthcare —Robbinsdale, MN
- $52.46 - $81.30 an hour
- 8 hour shift
- Hybrid work
- Nursing
- RN License
- Bachelor's degree
- Health insurance
- Tuition reimbursement
14d
Denials & Appeals Administrator (RN)
Boston Medical Center —Remote
- $43.03 - $62.50 an hour
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
Utilization Review RN
Beth Israel Lahey Health —Boston, MA
- $38.11 - $98.61 an hour
- Full-time
- Nursing
- RN License
- Hospital
RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days
John Muir Health —Concord, CA
- $89.23 - $121.58 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
Concurrent Utilization Review Nurse, RN
NeueHealth —Los Angeles, CA
- $74,286.15 - $111,429.23 a year
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Oncology Prior Authorization Case Manager, Non-RN - Remote
University of Miami —Miami, FL
- Full-time
- Remote
- Mid-level
- Bachelor's degree
- Experience equivalent to degree accepted
- Health insurance
- Dental insurance
Case Manager Registered Nurse
CVS Health —Texas
- $60,522 - $129,615 a year
- Full-time
- Remote
- Nursing
- RN License
- Residential
- Health insurance
- Dental insurance
10d
RN Care Manager/UR - Remote - PRN
LCMC Health —New Orleans, LA
- Part-time
- Remote
- Nursing
- RN License
- Mid-level
Quick Apply
Clinical Review & Correspondence RN
Cohere Health —Remote
- $31 - $35 an hour
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Health savings account
Quick Apply
Utilization Review Specialist (RN) – Work From Home
Concierge Home Care —Jacksonville, FL
- $65,000 - $85,000 a year
- 12 hour shift
- Remote
- Background check
- RN License
- Mid-level
- Health insurance
- Dental insurance
Case Manager Nurse-RN
Personify Health —Remote
- $36 - $38 an hour
- Email
- Nursing
- RN License
- Computer literacy
- Health insurance
- Dental insurance
10d
Care Transitions Utilization Review RN, Per Diem
Beth Israel Lahey Health —Boston, MA
- $38.11 - $98.61 an hour
- Call employer
- Nursing
- RN License
- Hospital
RN II, Primary Nurse Care (Case Manager-REMOTE)
Horizon Blue Cross Blue Shield of New Jersey —Hopewell, NJ
- $79,100 - $105,945 a year
- Full-time
- Remote
- Bilingual
- Nursing
- Microsoft Excel
- Health insurance
- Dental insurance

I want to receive the latest job alert for Rn Utilization Manager

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Rn Utilization Manager jobs near

Utilization Review Nurse jobs in Trenton, NJ

Registered Nurse jobs in Remote

Utilization Review Nurse jobs in Boston, MA

Registered Nurse jobs in Texas

Utilization Review Nurse jobs in Los Angeles, CA

Registered Nurse Case Manager jobs in Washington, DC

Registered Nurse Case Manager jobs in Concord, CA

Correspondent jobs in Remote

Care Manager jobs in New York, NY

Registered Nurse Case Manager jobs in Los Angeles, CA

Case Manager jobs in New York, NY

Utilization Review Nurse jobs in Jacksonville, FL

Utilization Review Nurse jobs in Clinton, MD

Registered Nurse Case Manager jobs in Remote

Prior Authorization Specialist jobs in Miami, FL

Utilization Review Nurse jobs in Portland, ME

Remote Nurse Utilization Review jobs in Massachusetts

Utilization Management jobs in Remote

Registered Nurse jobs in Commack, NY

Utilization Review Nurse jobs in Spokane, WA

RN Team Lead Utilization Review

MedStar Health -
Clinton, MD

Apply Now

Job Details

Full-time
$89,065 - $162,801 a year
7 days ago

Qualifications

Inpatient experience
RN License
Acute care facility experience
Bachelor's degree
Bachelor's degree in nursing

Full Job Description

About this Job:

In-patient Utilization Review RN experience highly preferred. Candidate must live in the DC/Baltimore region

General Summary of Position
Supervises the daily activities of the Utilization Review Team. Manages daily assignment ensuring all UM tasks are completed each day. Collaborates with the physician nurse case manager social worker and other members of the health care team to meet individualized patient outcomes. Assists the Director in managing the daily departmental operations with the goal of maintaining adequate staffing levels and efficient workflow. Acts as a resource and mentor to the Utilization Review staff.

Primary Duties and Responsibilities

Supervises daily activities of UM team. Monitors and arranges for adequate staffing to ensure appropriate Utilization Review coverage for units. Monitors daily workflow issues and addresses issues related to workflow in collaboration with the director as necessary.
Acts as a resource and mentor for UM Team. Oversees the orientation of new UR Coordinators by establishing the plan and monitoring progress in conjunction with other staff as necessary Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services staff meetings orientation and formal educational offerings. Completes continuing education to maintain knowledge base.
Collaborates with and assists the nurse case manager and social worker to meet the patients' continuing health needs in a high-quality cost-effective manner by identifying patients in need of case management. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient LOS insurance and discharge needs.
Collects quality improvement data in accordance with approved indicators. Monitors and audits staff UM reviews for completeness and compliance with standards. Recognizes potential problems and provides education to staff.
Utilizes research methods to collect tabulate and analyze data in collaboration with the case management team medical staff and hospital performance improvement initiatives. Assists CM Leadership in implementing strategies to correct or modify trends seen through data analysis and outcome monitoring.
Confers and collaborates routinely with the physician advisor and attending physicians to resolve problems regarding acuity and level of care.
Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Identifies insurance information obtains authorization communicates with financial counseling and assigns appropriate length of stay for admission.
Implements strategies to avoid denials including potential denial notification to attending physician. Issues letter of non-coverage for Medicare or third-party payers according to policies and procedures. Communicates utilization plans to case management team. Evaluates concurrent and retrospective denials for appeal opportunities. Generates appeal letters based on knowledge of clinical severity and intensity.
Manages the department in the Director's absence. Keeps Director informed about issues related to staffing and problem areas. Keeps Director informed about issues related to quality risk patient/family issues and concerns allocation of resources and vendor/payer issues. Assists the Director in monitoring performance issues. Contributes to the performance evaluation process by giving feedback to the Director and helping create professional development plans for UR Coordinators.
Participates in multidisciplinary quality and service improvement teams.
Performs admission reviews and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age specific needs. Interacts with and assists third party payer reviewers to facilitate appropriate care and ensure payment of services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources.

Minimal Qualifications
Education

Bachelor's degree in Nursing required

Experience

3-4 years clinical experience in acute care setting required
2 years Case Management or Utilization Management experience preferred
1-2 years leadership experience preferred

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure the District of Columbia or State of Maryland depending on work location required
CCM - Certified Case Manager preferred

This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.

Apply Now

Refine Your Search

Rn Utilization Manager jobs

RN Team Lead Utilization Review

RN Case Manager - Surgery Services

Utilization Review RN - FT - Day - Utilization Resource Management Trenton NJ

RN Case Manager

Nurse Case Manager, Utilization Management

RN Case Manager

Care Manager, Concurrent Review (Remote)

RN Manager of Utilization Management

Denials & Appeals Administrator (RN)

Utilization Review RN

RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days

Concurrent Utilization Review Nurse, RN

Oncology Prior Authorization Case Manager, Non-RN - Remote

Case Manager Registered Nurse

RN Care Manager/UR - Remote - PRN

Clinical Review & Correspondence RN

Utilization Review Specialist (RN) – Work From Home

Case Manager Nurse-RN

Care Transitions Utilization Review RN, Per Diem

RN II, Primary Nurse Care (Case Manager-REMOTE)

I want to receive the latest job alert for Rn Utilization Manager

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected