Top 4766 Utilization Manager Rn Jobs

RN - Case Manager - AS Utilization Management - Walnut Creek - Full Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $87.06 - $118.62 an hour
- 8 hour shift
- Nursing
- Microsoft Outlook
- RN License
Utilization Management Nurse (CA)
Toney HealthCare Consulting, LLC —Remote
- $89,228.53 - $107,458.02 a year
- 8 hour shift
- Remote
- Nursing
- RN License
- Mid-level
Quick Apply
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
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
Care Manager RN - LA Market - Remote
UnitedHealthcare —Metairie, LA
- $60,200 - $107,400 a year
- Full-time
- Remote
- Nursing
- RN License
- Pass drug screening
RN Case Manager
Zócalo Health —Los Angeles, CA
- $85,000 a year
- Full-time
- Remote
- RN License
- Writing skills
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
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
Manager, Utilization Review
Health Business Solutions LLC —Remote
- Nursing
- RN License
- Mid-level
14d
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
Transfer Coordinator (RN) - Utilization Management (Per Diem, Days)
Enloe Medical Center —Chico, CA
- $54.38 - $73.41 an hour
- 12 hour shift
- Remote
- CPR Certification
- Nursing
- Microsoft Excel
- Health insurance
- Dental insurance
10d
RN Case Manager - Compact License Required - Remote
Optum —Phoenix, AZ
- $60,200 - $107,400 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Opportunities for advancement
Quick Apply
3d
AUSTIN TX Utilization Review RN
Bracane Company —Dallas, TX
- $35 - $40 an hour
- Full-time
- RN License
- Mid-level
- Patient care
Quick Apply
10d
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 Nurse
Cobalt Benefits Group LLC —Dallas, TX
- $90,000 - $98,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
Quick Apply
Utilization Review Manager - PRN
Assurance Health System, LLC —Remote
- Part-time
- Remote
- Psychiatry
- RN License
- Mid-level
- Health insurance
- 401(k)
Quick Apply
3d
Care Manager, Concurrent Review (Remote)
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
RN Reviewer
Cohere Health —Remote
- $33 - $35 an hour
- Full-time
- Remote
- Google Workspace
- Nursing
- RN License
- Paid parental leave
- Health savings account
Quick Apply
Nurse Specialist II
Qlarant —Remote
- $56,055 - $83,665 a year
- Remote
- RN License
- Mid-level
- Bachelor's degree
Quick Apply
Utilization Management Nurse Specialist RN II
L.A. Care Health Plan —Los Angeles, CA
- $88,854 - $142,166 a year
- Weekends as needed
- Nursing
- Microsoft Outlook
- RN License
- Wellness program
- Health insurance
11d
Case Manager
Luminare Health —Remote
- $57,800 - $108,500 a year
- Full-time
- Remote
- Bilingual
- Nursing
- Microsoft Outlook
- Paid parental leave
- Paid holidays

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Utilization Manager Rn jobs near

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

John Muir Health -
Walnut Creek, CA

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Job Details

Full-time
$87.06 - $118.62 an hour

Qualifications

RN License
BLS Certification

Full Job Description

Job Description:

Job Profile Summary
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. The RN CM, SW and care transitions team work in a collaborative approach, along with the individual patient and or their caregiver, to remove barriers for the safe transition of the patient.

Education:

Associate's Degree Accredited School of Nursing or
Degree/Diploma Obtained - Accredited School of Nursing Required

Experience:

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

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 knowledge of common diagnoses and procedures and the impact this will have to patients/families and their ability to manage their care outside of the hospital. Specialized knowledge 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 knowledge of geriatrics and the impact to health and function in the aged as well as a working knowledge 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, InterQual, Allscripts, and Microsoft Outlook.

Work shift: 0800-1630

Days worked per week: 5

Hours worked per day: 8

work schedule:

Sunday to Wednesday (week 1)

Sunday-Thursday (week2)

Work Shift:

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

Pay Range:

$87.06 - $118.62 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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RN - Case Manager - AS Utilization Management - Walnut Creek - Full Time - 8 Hour - Days

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Care Manager, Concurrent Review (Remote)

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