Top 6671 Utilization Management Rn Jobs

RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $89.23 - $121.58 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
Utilization Management Clinical Reviewer
CuraFi —Remote
- $140,000 - $160,000 a year
- Full-time
- RN License
- Senior level
- Communication skills
- Health insurance
- Dental insurance
Quick Apply
12d
Medical Management - Utilization Management RN 145-2026
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
10d
Utilization Management Registered Nurse (RN) - Remote
Guidehealth —Chicago, IL
- $70,000 - $75,000 a year
- Full-time
- Remote
- Microsoft Word
- Nursing
- Microsoft Excel
- Paid parental leave
- Disability insurance
13d
Utilization Review RN, Case Management/UR, Full Time, Day Shift, Job ID # 1815702
Palmetto General Hospital —Hialeah, FL
- Full-time
- Microsoft Outlook
- RN License
- Computer literacy
12d
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
RN - Case Manager - AS Utilization Management - Part Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $89.23 - $121.58 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
Quick Apply
Utilization Management RN
WelbeHealth —Los Angeles, CA
- $99,309.58 - $131,088.64 a year
- Remote
- Mid-level
- 3 years
- Supervising experience
- Health insurance
- Dental insurance
Quick Apply
9h
Clinical Reimbursement Specialist (MDS) - Groves Center-3K retention bonus
The Groves Center —Lake Wales, FL
- Full-time
- Background check
- CPR Certification
- Microsoft Outlook
- Health insurance
- Dental insurance
Clinical Educator (RN) - Inpatient Hematology / Oncology & Bone Marrow Transplant Unit at Arthur M. Blank Hospital
Children's Healthcare of Atlanta —Atlanta, GA
- Full-time
- Nursing
- RN License
- Bachelor of Science
Quick Apply
Director of Surgical Services
GRAHAM REGIONAL MEDICAL CENTER —Graham, TX
- Up to $160,000 a year
- Full-time
- Nursing
- Anatomy knowledge
- Management
- Relocation assistance
- Health insurance
Quick Apply
Pediatric Palliative Care Specialist- RN, Full-time
TRANSITIONS LIFECARE —Raleigh, NC
- Weekends as needed
- Spanish
- CPR Certification
- Nursing
Quick Apply
Nurse Manager (RN)- Medical/Surgical UNIT - Andalusia Health
Andalusia Health —Andalusia, AL
- Full-time
- Acute care
- Background check
- Nursing
- Health insurance
- Dental insurance
Quick Apply
14d
Nurse Educator (RN)
Wake Robin Corporation —Shelburne, VT
- $36.70 - $44.77 an hour
- Weekends as needed
- Nursing
- RN License
- Mid-level
- 403(b) matching
- Disability insurance
Quick Apply
Registered Nurse (RN) Infusion RN | Day Shift | $3,845 weekly
Kiwi Healthcare —Sitka, AK
- Up to $3,845 a week
- Travel nursing
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
3d
ASC Nurse Administrator - Louisville | No Weekends, Evenings, or On Call!!!
CPIhealth —Louisville, KY
- $115,000 - $125,000 a year
- Full-time
- Nursing
- RN License
- Bachelor of Science
- Disability insurance
- Health insurance
Quick Apply
Nursing Director of Women's Services
Navarro Regional —Corsicana, TX
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
Travel Director of Nursing
Trio Healthcare —Roanoke, VA
- Travel nursing
- English
- Travel
- Recruiting
Quick Apply
Medical-Surgical Director (FT)
Edgerton Hospital —Edgerton, WI
- Full-time
- Nursing
- RN License
- Hospital
- AD&D insurance
- Disability insurance
Quick Apply

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

John Muir Health -
Walnut Creek, CA

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Job Details

Full-time
$89.23 - $121.58 an hour

Qualifications

RN License
BLS Certification
Bachelor's degree
Bachelor's degree in nursing

Full Job Description

Job Description:

The role of the inpatient case manager is one of patient advocate of appropriate utilization of resources. The inpatient case manager applies the process of assessment, planning, implementation, monitoring, evaluation and coordination of care to meet the patient’s health care needs through hospitalization and transition back to the community and does this in coordination with the interdisciplinary health team.

The RN Case Manager is expected to function within the full scope of the nursing practice with specialized focus on care coordination, compliance, transition management, education, and utilization management.

Education:

Bachelor's Degree Accredited School of Nursing Required

Experience:

3 years Nursing - Medical/Surgical Preferred or
3 years Nursing - Critical Care Preferred
2 years Care Coordination - Case Management Preferred or Equivalent Work Experience

Certifications/Licensures:

RN Registered Nursing - California Board of Nursing Required
BLS Basic Life Support - American Heart Association Required
ACM Accredited Case Manager - ACMA American Case Management Association or
CCM Certified Case Manager - CCMC Commission for Case Manager Certification Strongly Preferred

Skills:

Strong written and verbal communication skills.
Effectively motivates teams.
Strong knowledge of Medicare and Medi-Cal guidelines and benefit resources as applicable to hospitalization and transition planning.
Working know ledge of common diagnoses and procedures and the impact this w ill have to patients/families and their ability to manage their care outside of the hospital. Specialized know ledge may be required for certain areas of practice.
Knowledge of individual and family development over the life span, and the influences of cultural and spiritual values in health care.
General knowledge of commercial coverage plans and usually covered benefits. Strong understanding of various reimbursement models and impact to care delivery, patient management and reimbursements such as ACOs, DRGs, Full Risk, etc.
Strong understanding of the criteria, rules and regulations around Inpatient, Observation and Outpatient levels of patient management.
Strong know ledge of geriatrics and the impact to health and function in the aged as w ell as a working know ledge of chronic/progressive disease states such as CHF, COPD, Diabetes and End Stage Renal Disease, etc.
Clear understanding of the role of the inpatient Social Worker and Palliative Care Resources.
Ability to plan, organize, manage time and prioritize work in collaboration with others.
Ability to work independently and as a part of a multidisciplinary team.
Effective problem solving and conflict resolution skills.
Ability to work respectfully and creatively with clients of diverse functional abilities, social, economic, and cultural backgrounds to support both client autonomy and client safety.
Leadership skills to delegate and provide direction/guidance to staff and hold others accountable.
Able to learn and work in a variety of computer programs, including EPIC, Allscripts, InterQual, and Microsoft Outlook.

Fixed Schedule:
Week 1: Sun-Wed
Week 2: Sun-Thurs

Work Shift:

08.0 - 08:00 - 16:30 No Waive (United States of America)

Pay Range:

$89.23 - $121.58 Hourly

Offer amounts are based on demonstrated/relevant experience and/or licensure.

Pay will be adjusted to the local market if hired outside of the Bay Area.

Note: Positions at JMH which are exempt (not eligible for overtime) under the level of Manager are listed as hourly for compensation purposes on this posting. The work shift will contain the word ‘exempt’ on it.

Scheduled Weekly Hours:

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Refine Your Search

Utilization Management Rn jobs

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

Utilization Management Clinical Reviewer

Medical Management - Utilization Management RN 145-2026

Utilization Management Registered Nurse (RN) - Remote

Utilization Review RN, Case Management/UR, Full Time, Day Shift, Job ID # 1815702

Denials & Appeals Administrator (RN)

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

Utilization Management Nurse

Utilization Management RN

Clinical Reimbursement Specialist (MDS) - Groves Center-3K retention bonus

Clinical Educator (RN) - Inpatient Hematology / Oncology & Bone Marrow Transplant Unit at Arthur M. Blank Hospital

Director of Surgical Services

Pediatric Palliative Care Specialist- RN, Full-time

Nurse Manager (RN)- Medical/Surgical UNIT - Andalusia Health

Nurse Educator (RN)

Registered Nurse (RN) Infusion RN | Day Shift | $3,845 weekly

ASC Nurse Administrator - Louisville | No Weekends, Evenings, or On Call!!!

Nursing Director of Women's Services

Travel Director of Nursing

Medical-Surgical Director (FT)

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