Top 5859 Utilization Manager Rn Jobs

Care Manager (RN) *Baltimore
Maryland Care Management Inc —Baltimore, MD
- Full-time
- Hybrid work
- Nursing
- RN License
- Hospital
- Disability insurance
- Health insurance
RN Team Lead Utilization Review
MedStar Health —Clinton, MD
- $89,065 - $162,801 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Inpatient
Quick Apply
Service Line Manager (RN) Ambulatory Surgery Center Full Time Day
Jersey City Medical Center —Jersey City, NJ
- $127,512 - $165,766 a year
- Full-time
- Nursing
- RN License
- 5 years
- Paid parental leave
- Paid holidays
Registered Nurse :: Local / Travel - Quick Start :: Urgent Hiring :: NM
Teamware Solutions —New Mexico
- $65 - $72 an hour
- Temporary
- RN License
- Mid-level
- Travel
- Relocation assistance
- Flexible schedule
Quick Apply
4h
RN Claims Review and Utilization Management (CR/UM)
MedHealth —Oklahoma City, OK
- Full-time
- Microsoft Word
- Nursing
- RN License
Quick Apply
8d
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
Senior Manager, Utilization Management
1199SEIU Family of Funds —New York, NY
- $125,400 - $156,700 a year
- Full-time
- Nursing
- 6 years
- RN License
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
Utilization Management Clinician I
Community Health Plan of Washington —Seattle, WA
- $35.92 - $55.67 an hour
- Full-time
- Mid-level
- Analysis skills
- Critical & Intensive Care
- Paid jury duty
- Health savings account
Quick Apply
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
Sr. Manager of Member Engagement
Private Health Management —Remote
- $120,000 - $180,000 a year
- US work authorization
- Senior level
- Leadership
- Health insurance
- Dental insurance
Quick Apply
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
Utilization Management RN (Hybrid)
TEXASCONNECT INC —Dallas, TX
- Weekends as needed
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Relocation assistance
InterQual Senior Clinical Education Consultant (RN) - Remote
Optum —Chicago, IL
- $91,700 - $163,700 a year
- Full-time
- Hybrid work
- Spanish
- Nursing
- RN License
- Health insurance
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
Quick Apply
Utilization Review RN
Beth Israel Lahey Health —Boston, MA
- $38.11 - $98.61 an hour
- Full-time
- Nursing
- RN License
- Hospital
Utilization Review Nurse
Cobalt Benefits Group LLC —Orlando, FL
- $90,000 - $98,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
Quick Apply
Case Manager, Registered Nurse (Oncology experience required)
CVS Health —Oregon
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
Utilization Review Manager - PRN
Assurance Health System, LLC —Remote
- Part-time
- Remote
- Psychiatry
- RN License
- Mid-level
- Health insurance
- 401(k)
Quick Apply
1d
Senior Product Manager – Medication Management (PharmD or RN Preferred)
Cantata Health Solutions, LLC —Remote
- $115,000 - $135,000 a year
- Remote
- Nursing
- 7 years
- RN License
- Disability insurance
- Health insurance
Quick Apply

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Care Manager (RN) *Baltimore

Maryland Care Management Inc -
Baltimore, MD

Apply Now

Job Details

Full-time

Benefits

Disability insurance
Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Medical law
RN License
Presentations for conferences or internal meetings
Employee relationship building
Managing patients as a nurse case manager
ADA compliance
Computer hardware
Productivity software
Training delivery
Disability rights laws

Full Job Description

Description:

This is a flexible, hybrid position involving regular collaboration with teams at Saint Agnes Hospital and approximately 30% onsite presence

Summary/Position Objectives:

This position is responsible for the planning, development, implementation, and timely oversight of care plans for members with identified Care Management (CM) needs. The incumbent is responsible for managing the care management process as defined by improving coordination, continuity, accessibility, and appropriate utilization of health care services and community resources for high risk and special needs members.

About Maryland Care Management, Inc. (MCMI)

Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.

Why join us?

MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans.

Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to positively impact our members' lives.

What You'll Do:

Assists in developing, maintaining, and monitoring processes to promote the timely identification and assessment of high risk and special needs members.
Serves as an interdisciplinary team member in management of identified members, performing clinical/social determinants of health assessments and in collaboration with physicians, determining medical needs.
Conducts telephone or face-to-face interviews of members to identify risk factors and the need for care management.
Fosters professional networks and relationships with service and resource providers to promote continuity and quality of care for members.
Initiates, develops, plans, and implements care plans designed to promote the delivery of quality care and service to members with identified CM needs.
Utilizes clinical judgment to discharge members from care management according to plan policies and procedures.
Maintains care management records according to plan policies and procedures and ensures data integrity in health plan information systems.
Collects, evaluates, and reports clinical, functional and program activity as applicable.
Identify cases to assess for impact of care management services, may assist in the collection of data.
Educates members' medical providers regarding the members' special needs to ensure consideration to the unique needs of the patients in treatment planning.
Coordinates and communicates with community support and social service systems for members.
Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration.
Assists with the development of policies and procedures related to care management.
Communicate effectively with supervisor/manager regarding departmental issues, member issues, program status, compliance issues, etc.

Secondary Functions:

Following HIPAA guidelines, the Care Manager maintains confidentiality of patient information and adheres to appropriate release of medical information procedures.
Demonstrates an understanding of the functions of other departments, communicates with other departments appropriately and maintains positive working relationships.
Identifies and reports gaps in the service delivery system.

Requirements:

Knowledge and Skills:

The ability to successfully utilize Microsoft Office suite and common computer and office hardware is necessary.
Ability to conduct presentations and training before small and large groups.
Knowledge of the Americans with Disabilities Act of 1990.
Demonstrated skill in written and oral communication to include presentations and training before small and large groups.

Education and Work Experience:

Registered Nurse with current state license.
2+ years of clinical nursing experience in acute care or community setting.
Demonstrated experience helping members using community agencies.
2 years of care management experience.
Knowledge of Managed Care Programs (preferred).
BSN (preferred).
CCM (preferred.

EEOC Statement:

Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, or any other characteristic protected by law. This commitment extends to all aspects of employment, including hiring, promotion, compensation, benefits, training, social and recreational programs, and all other conditions and privileges of employment.

As a healthcare organization, we recognize the vital importance of inclusivity in delivering quality care to our patients. We strive to foster an environment where individuals of all backgrounds feel respected, valued, and supported. We aim to better comprehend the unique needs of our patients and provide healthcare services that are culturally competent and sensitive.

We encourage candidates from all backgrounds to apply and join us in our mission to provide compassionate and inclusive healthcare. We believe that a diverse workforce enriches our organization and allows us to better understand, connect with, and serve our diverse patient population.

Apply Now

Refine Your Search

Utilization Manager Rn jobs

Care Manager (RN) *Baltimore

RN Team Lead Utilization Review

Service Line Manager (RN) Ambulatory Surgery Center Full Time Day

Registered Nurse :: Local / Travel - Quick Start :: Urgent Hiring :: NM

RN Claims Review and Utilization Management (CR/UM)

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

Senior Manager, Utilization Management

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

Utilization Management Clinician I

Denials & Appeals Administrator (RN)

Sr. Manager of Member Engagement

Concurrent Utilization Review Nurse, RN

Utilization Management RN (Hybrid)

InterQual Senior Clinical Education Consultant (RN) - Remote

Claims - Care Manager, RN, Claims

Utilization Review RN

Utilization Review Nurse

Case Manager, Registered Nurse (Oncology experience required)

Utilization Review Manager - PRN

Senior Product Manager – Medication Management (PharmD or RN Preferred)

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